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95-718(1�?�!�I fl � Presented By Referred To 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 RESOLUTION SAINT PAUL,�9 Council File � Green Sheet # Committee: Date RESOLVED, that the Saint Paul City Council consents to and approves of the appointmenu, made by the Mayor, to the CERTIFICAI'E OF COMPETENCY BOARD OF EXAMINERS. BUII,DING OFFICIAL Jan Gasterland CONCRETE MASONRY Duwaine Knajdek Frank Berg Richard Gilbert FUEL BURNER Dennis CLada David Hodgson Richard Pesek Jerold Maleitzke LATHER AND PLASTERER Dan Peltier Aetb Holzschuh Kenneth I.aBrasseur WARM AIIt HEATING Eugene Binder Bruce Stafford Donald Geng George Albers 7ann Peyer PLUMBING Bernie Bullert Mickey Nasseff William Rascher Marty Zangs Rober[ Schwartzbauer REFRIGERATION Larry Jordan John Hendrickson John Matthews Ronald Rice STEAMFTl"TING Doug Olson Paul Hackl Pau] March Charles Rosenberger All terms will expire on July 1, 1998. S-7i � 3!G 33 !2 Requested by Department of: By: Form Approved by City Attorney B Y = ,:��\y-a�'�` By: Approved by M�or:" Date By: 1�5� Approved by Mayor for Submission to Council BY= !"�-����� Adopted by Council: Date Adoption Certified by Council Secretary 9S�i� DEPp�1'TM�OY�S ���IlC2 DATEINITIA7E0 'y� 31633 M 6/14/95 GREEN SHEET . INITIAUDATE INRIAVDATE CONTACi PERSON & PHONE � DEPARTMENT �IRECTOfl CT' COUNG� Roger CuTtis� 266-8531 �ssicx CfTYATfORNEV INCLERK NUYBERFOA MUST BE ON COUNqI PGENOP BY (DAT� pp�� BUOGET DIRECfaft O FM. & MGL SERVICES DIR. OflDER � MpYOP (OF ASSISTANn ❑ TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE) ACTION REQUESTE�: Appointments and reappointments to the CERTIFICATE OE COMPETENCY BOARD OF EXAMINERS. RECAMMENDATIONS: Appmve (A) or Reject (R) pERSONAL SEHVICE CONTRACTS MUST ANSWER THE FOLLOWING �UESTIONS: _ PLANNMG COMMISSION _ CIVIL SERVICE COMMISSION �- Has Mi5 persoMirm ever worked under a coMraGt for Mis department? - _ CIB COMMRTEE _ �'ES NO _ STAFF 2. Has this personRirm ever been a city employee? — YES NO _ DISiRICT COUAT _ 3. Does this person/firm possess a skill not normally possessed by any curtent ciry employee? SUPPORfSWHICHCAUNGILO&IECTIVE? YES NO Explafn all yes answers on separate sheet antl ettach to green shcet INITIATING PROBLEM, ISSUE.OPPORTUNIN�Who, Whet. WM1en, Where, Why)� None. ADVANTAGES IPAPPROVED: Appointments and reappointments to the CERTIFICATE OF COMPETENCY BOARD OF EXAMINERS. SEE LISTING ON COUNCIL RESOLUTION. DISADVANTAGES IF APPROVED� � �`�� 1;��'4.q:qS DISADVAMAGES IF NOTAPPROVE�: TOTAL AMOUNT OF TRANSACTION $ COS7/REVENUE BUDGETED (CIRCLE ONE) VES NO FUNDING SOURCE ACTIVITV NUMBER FINANGAI INFORMATIpN: (EXPIAIN� ���i� Interdepartmental Memorandum CITY OF SAINT PAUL TO: Council President Dave Thune Councilmember Janice Rettman Councilmember Jerry Blakey Counciimember Roberta Megard Councilmember Michael Harris Councilmember Marie Grimm Councilmember Dino Guerin FROM: Roger C. Curtis � Jean Kazpe Mayor's Office DATE: f'7�1 7une 12, 1995 CERTIFICATE OF COMPETENCY BOARD OF EXAAa1VERS Mayor Norm Coleman has recommended the reappointments and appointments of the following people to the Certificate of Competency Board of Directors. BUII,DING OFFICIAL 7an Gasterland CONCRETE MASONRY Duwaine Knajdek Frank Berg Richazd Gilbert F[JEL BURNER Dennis Chada David Hodgson Richard Pesek Jerold Maleitzke PLUMBING Bernie Bullert, Water Utility Mickey Nasseff William Rascher Marty Zangs Robert Schwartzbauer REFRIGERATION Larry Jordan John Hendrickson John Matthews Ronald Rice 9���� c�ry coun�i� Page T�vo June 7, 1995 LATHER AND PLASTERER Dan Peltier Herb Holzschuh Kenneth LaBrasseur WARM AIR HEATING Eugene Binder Bruce Stafford Donald Geng George Albers Jann Peyer - Alternate STEAMFPPTING Doug Olson Paul Hackl Charles Rosenberger Paul Mazch All terms will expire on 3uly l, 1998. Copies of the applications for the new members are attached. Please call me at 266-8531 if you have any questions. MAY-26-1995 11;29 GRRTNER REFRIG 612 920 0766 P.02 c3526.'95 1G�53 , iD�A�ociar,ion �JPiice h(al�%Z-ti].'L-ki4b"yb'/Y rHac ���}�/� ...., w •iaJ G7��d �+iN� vc�iJL M7fOR'S OFFIfE 632 256 8573 P.02�03 1 ' apatcs ar'rsa xnYOa aso c,sTx s�� 6ATNT x'\OL� !lI2YLy880TA b3102 � 26G�8926 xnme: �,�.¢_ � /��MQ /21C,/��o/'/ Hona.adscaa: _ r��� ��' Cr,LJ=�-.� �iP_ JIJ l� � ^ 3� ,L / X�znet 03t,r yj,p � ?cleph�ne �m�er: ceoee� j�l,�—Ll7o�'�i7SZ� � ( _;�l>� , ?�annirrg Di�criec Co�mci]: Y=et�ZYCd Mn�.7.j.uq /.6d Qhvt ia �our'oecupRCi Ylnto ' of ,F.mpIaymefAC c Cit7 Cmt7tcil Far1: Ccmqii�eo(s) Appliod Fars IIheC 6k1].i�c/trniaing oz rspozieocr. do �av. po��nRa $ar the commLt•tce(s) poz Yhich yw ar,ck aypo3.nCmop[ct ; -w.,. - - 17te �n£asmat�ou tnc}.udsd tn t1+3a spp7.iescion ;a conai4cred Qrtvata dar.e according co LM � NimaasoYa Qosermant Dnte Ftaeticnn Act. Ax ti zesnit, L•bic �,nYoxmati.an is noz zeleased eo ths geneX�k }+ttb2lc. � (a�) luv.�l _ rJITX /C7��°`J . • �.,_�„ 7 MRY-26-1995 11=30 GARTNER REFRLG 612 9Z0 0766 ;G526 '9b 1U:�3 fU�Rssoc+ation urr�r� hHx.x-blL n�r�F, , __ _ ,,.-..,. ,�.�m rm�.�_ rHt�tx•5 �(CE 512 266 �73 P,03�03 • x�:�lv �oN� � Addrtss Phana: Neae;. P.04 a 95'�/�l %�It�u�u[��3i,�.u��1�/ :sr t ��r.:��'ii.,: �i�- ,t. . . . t1 ,; " .t l�.c�t �..a" s : .,,. ��� � •_ AY�asone QQS rauz Sn;ereRt isi chia parsicvlez committee JGcve �su had previoum eoncack vi�h tho eameir.r,ne Sar �L1ch yw oxe taakia�g sp�licef:ian. if ao, iAwn, an4 cixcunaCancasT �1�-1�f�bv�z'' .. _� (�G� 2 (.Y�� � � CIR' --- - ..w tn aa Rtetmp�. Lo rns,�e tbar coaastxer, xopFesentattnn r�f2aeaR r.Ae makeap af o«e comim��cT, yleor�o aheci the 11r�a nppiiubtr. �, 7w. Thu �x,fa=macion !.n a=rt.oc7L� vo] Unknt�', ,.�„ hh,itC �CatteAR3an9 ,_,_„ BibP+II1c ,� 8�sek {!.£r,f,can Amerienn) _, �n3�n or ]�oaifie 1'nlnndar _.� JUUnXic,Rn indinn ur Alnaican f�aklmn � ,"�, 1Snle ' ___,� Pabele biaabltds Yes __,,,,,_ �pq � DeCe of Birth: If sqacinl sc�omwdatiane arc anxd�d, y�aeaa aprcit7- �_�C _ _ Ifav.Bdd �o}i fae►r a6out Yhis opentog? __���� �'L�'"u��G//C— �-d?9T�?'"�� � TQTf� P.03 TOTAL P.04 ��'�il� �Ti!'1eTC. �1'�^-� - - MRY-26-1995 11�30 I ,, . , r • � Pasition: Industry Eacperience: GRRTNER REFRIG 612 920 0766 P.03 ` srocz�rxY JOHN R. HEN'URICKSON GARTN��t REFItIGERATiON & MTG., TNC. President/Project Mana�ement and Sales ` 30 Years Educat7or�: � University of Minrtesota - 2 Years �; Dunwoody Technirzl InsYitute - 2 Years Pipefitters Apprenticeship Program ' '� � Prick Graduate Refrige�adon Training Program Frick Food Freezing Training Program 9�7�� Organization Invplvement; AST-iRA� American Society of HeatinB, Refrigeratin�3 and Air Conditioning L-ngineers ; - TC 10.5 Refrigerated Warehouse Committee - Corresponding Member 1991 to Present , - Chairman 1988 to 1991 . - Member 1984 to 1988 RETA Refrigeration Bngineers and Technicians Association - Chairman 1993 - President 1992 - fixecutive Vice President 199I . Vice President 1980 - Sergeant at Arms 1989 - I3oard Member 1483 to 1988 MMCA Minnesata Mechanical Contractors Association - President 1993 - Vice President 1992 - Board MemUer 1991 to )995 MCA Mechanical Contractars Association - Member IJATt 7ntema4ional Instilute of Ammonia ]tef�igera[ion - Member " - Refrigeration Workshop industrial Staf� 1992 to Present IARW International Association of Refrigerated Warehouse - Member MRY-24-1995 14�21 FROM LIEP-HID ST. PRUL. MN TO 68513 P.02/03 r� � I �J 08 390 CITY R q,� //� CTY PAEb, MINNBSOTA SSioa � ' 265-8526 x��- /�A2i �R1 ZRN�s� � somg edar�8 - 3 D strces zip Te2ephone z�nmber: �aome� �/ �' 3. �_. 3T � �a�k� 2 6 6 9 as � Plaaaiag D£stzict CosmaYl: Prefexxed 2Ssiliug 6.ddress: Ahat is gour ocrupati Place�oi �plOymant: Committee(s) Applied For: City Cotmail 17ard_ Tha £n£oxmntian iaclnded Sa t�3s applicatioa is caaside=sd pr4vste 8ata accosding to tha x3anesota Govaxmant Data Yratticas Act. As a sasvlc, this SaPozmacion is noz relassaC eo che $enmzal public. . CQ� xa9. Ahnt sI¢lIs/traiaiag or expazxtrnca do yau pnssess £oz tha committee(a) for v'hich 7ws E88k appoinhacut? . �,� L , .- � ���� �e= �I� � t� Z � �S s .r n .,� e ) � Addrass - 3 _r, — / v - nadr4sF• �3 v T��1 n� S i 1 — � A . &snsons £or pouz iatezcst ia �1s paxticvlax comntittes:� 6�p! }�� �J ��'� � Eavo you had previous cantact vith Cha comm4ttoa for mhich you aze mak3n8 aPPlication. I£ so, rhan, sad a5xc`n°stances7 � _. .� _ . � In aa attempt La a�+�a th0t eaamtiktnicableet�tou%�ThSsleinPozmaLion ia st=ictlp eo�nmi�ty. pleasa check tha line appl y voluatarp. ti Yhite (�ucssisu) �lack (African Am�s5.�8aJ emssicar lhd3sa oz �laskaa 8sximo � 2laie Female Di.sablad. Xes � HispanSe 6sian or Pac4.Eic Tslandes na�'o� as�: ,�''-, � � Zf special accoa�odstions are needed, plensa spaei�• go.r did you hear abaut th�s opeaiug? TOTf� P.6:i TOTAL P.03 � � �� � �� OFFICE OF THE MAYOR 390 CITY HALL SAINT PAUL, MINNESOTA 55102 (612)266-8526 9s7�� �e���� f�AY � 2 1995 .'�s�'ia�ii,�;�`+�'a�'. �f'E'.`,":� Name: Jerold A. Maleitzke Home Address: 116 E. Little Canada Rd. Little Canada. Minnesota 55117 Street City Zip Telephone Number: (Home) 483-9766 (Work) 229-2368 Planning District Council: NONE City Council Ward: Mayor & City Council Preferred Mailing Address: 116 E. Little Canada Rd.. Little Canada_ Minnesota 55117 What is your occupation? Mana�er NSP Advantaee Service Place of Employment: Northem States Power - Gas Utility Committee(s) Applied For. Boazd of Examiner's for Certificate of Competency - Fu 6�- Y3ll RN Ei� What slrills/training or experience do you posses for the committee(s) for which you seek appointment? • T V I- Heatin,�& Sheet Metal • 916 Vocational - Drafting & Blueprints • Four Year State Endentured Ap�renticeship with Northem States Power on service of HVAC and apnliances and gas operations • Twenty-five (25) veazs of technical and vractical experience of service and installation's tranrinQ: instructor for two years on repairs for Northem States Power Company. • The nast five years with NSP Pve managed our repair business and dealt with technical and practical issues on a daily basis Part of my resp.onsibilities is to ensure that we aze in compliance with all codes and rezulations. • I also held the �sition of Cras Inspector for NSP for Gas Construction and Service Operations for The information included in this application is considered private data according to the Minnesota Government Data Prac6ces Act. As a-result, this information is not released to the general public. �s���r PERSONAL REFERENCES: Name• MarkNelson Address: 825 Rice Street, St. Paul Minnesota 55117 Y6one:_f Homel (Workl 229-2417 Name• Greg Palmer Address: 825 Rice Streek St Paul Minnesota 55117 Phone: (Homel (Workl 229-2332 Name• Jim Willson Address: 825 Rice Street St Paul Minnesota 55117 Phone: (Homel (Workl 229-2470 Reasons for your interest in this particular committee: Due to myposition with Northern States Power I am resnonsible for ensuring that we aze operatinQ in comnliance and that our contractors, whom we nartnershin with that provide repair services meet all requirements and city codes Also that both NSP and its contractors hold the proner ]icenses to perform the work I also like keening up-to-date on the re uirements of the city conceming our �as operations related to moving eas meters and house pininQ. Have you had previous contract with the committee for which you are making application. If so, when, and circumstances? In an attempt ta ensure that committee representation reflects the makeup of our community, please check the line applicable ta you. This information is strictly voluntary. X White (Caucasian) Black (African American) American Indian or Alaskan Eskimo _ `< Male Female Hispanic Asian or Pacific Islander Date of Birth: August 7. 1952 Disabled: Yes No X If special accommodations are needed, please specify How did you hear about this opening? Mazk Nelson from NSP inquired whether I wouid be interested in fillin�position. formerl�held by 7ohn Ness of NSP. 11AY-11-95 TNU 09:43 N S P ST.PRUL FRX N0. 612+2292370 _ _ _ -- �-- . �o,_, P. ol � �/l� 9 p Fax Not� (: t�r` ��� C G`{ "? `��� January 23, 1995 Mr. 7an Gastertand Building Code Officer Building Inspection and Design Ciry of St. Paul 350 St. Peter, Suite 310 St, Paul, MN 55102-1510 Dear Mr. Gasterland: This letter is in regard to filling the position on the St. Paul fom�erlq held by John Ness of NSP. and Examining Board I worked for a Iocal hearing dealer in the Service and Installatio� IIeZd in 1969 to 1976. Tn 19�6, I started with NSP's Gas 5ervice department, servicm appliances and heating and air conditioning equipment.l completed a four yeaz state ir�entured apprenriceship, to become a gas serviceman. I am presently Manager of NSP's Advantage Service appliance �pair program. In this position I work closely with heating and appliance repair dealer� do provide services to our customecs. I also have a current gas license. I would enjoy the opportunity to work with the City of St. Pauif to ensure I�SP is in compliance and up-to-date with the current codes, requirement � and regula6ons of St. Pau1 and share my operations experience with the related fields ufNSP Gas. Sincerely, �� Jerold A Mateitzke NSP Gas Utility 229 - 2368 + I (� � . L � -�. C�.�tia�ce L�i f=1'I � f�,��c�' a,�., N 7 � �!12;� Ci.���. ot' 11t i��`t� 12a�� 5511� MRY 22 '95 9�59 rWY-�,.�--1995 99: ct �� g3 , ����� FROM PIONEER POWER INC $qtNT PAUL hifiYQR'S OFFICE GBHICE oY T8� DlAYOR 39� C2TY H�LI, SAZNT YAIIIa� M2222t$SOTa � 25s-asze PAGE.B01 61Z 266 9513 P.O�-'� FA`�c "L 66�t�3Y�D 5s,ioa MAY 2 2 1995 9 �� 7 �� game: Douglas E_ Olson A�rAYi.�''� GFFICE soma eaarass: 2000 6reenbrier Street, Mapiewood, Minnesota 55117 Street City 2ip Telephone F�bnr• [Hom ) 612/772-1113 tYoz7c) 612/488-5561 Plaaaing D3atriet Couaeil: Git7 Crnmcil iiard: -- Fragarr�d 7sa5.ling eaaress: Pioneer Power Inc. 570 Hatch Avenue St. Paul Minnesota 55117 Yhat is your occugat3oat Project Manager � ^ Piace'af Fscpiaymsnt: Pioneer Power, Inc. commiztae(s) eppziad For: Steamfitter Committee �- � Ahat ski.2ls/tsainiag or esparinaen do 7on posanss #or the co�ittae(s) !er vh£ch pou sesk appoiat�ent? . Gradaate - St. ?aul NI - Pipefttter/Steamfitter, 1970 Teacher - St_ Paul N1 - PipefitterlSteamfitter, 1977-1985 Project Manager - Pioneer Power, Inc. - 1985 thru present State of Minnesota - Contractor Pipefitter license High Pressure Piping License Number 88271 City of St. Paul - Certificate of Competency M Steam A Certificate Number 12442 TF1� i,uPozmaLioa itic2udnd �a this appZication is coasidered private data sccordiag ta the Miaaesoca Gavnrmeat Data Pract£�es sc=. bs a rsau2t, this in£ormatioa ia not released zo rIse ganexal gublic_ (OVBS) g �,_Q/21/93 TO7RL P.@2 C'7 'JCC. ?S�`] OG�C f��7 fk�k Tf1T01 DOf-�� P�i1� �vw MRY 22 '95 15�45 FROM PiONEER POWER !NC MHY-..rc-'.9°5 11=?fl SAINT PALM1. MRYUh2'� UFFII:t O1G LOO .'7�l � V r'. VU �JG ��Q� JI.C�G I GYO�.� + �� 7b6 Transfer Road, St. Paul Minnesota SSi14 Fhona' � g 535-7552 646-2121 F�� Ray Schaefer �,g� 445 Cit Hail, St. Paul, Minnesota 55102 o k 26b-9041 Fhone ��,�- [.arr Jordan eaazass: 1633 Eustis Street St. Paul Minnesota 55 0 phona• 636-8934 Q OS�` - R � g � s f� y �e �nLe�.eg= ia t� p,azt;ealar committsa: Active contractor involved in High Pressure Piping. Save yon I�ad prsvious eontact 4i.tih the eoanaitten fax vhich ya� a�e ��B aPPl3cation. I£ so, vhaa and cizc�ataacesl' Ia aa actampt to ensurn t�at co�itt�ie=ab�Ieato tat4cn�r�la ti an�is co*�^•; �9. Pieasa chsck � 7-�6 app pQ voltsaraiY- Ahita (cancasiaa) HS.span3.c �_ Asiaa or Pac3fic Islsnder B1acY (Afxican A�e=i�� p�asricaa Indiaa os J1laskan Eskim° �_ 2ta.Ie 9-19-47 Pemala Dase of Birth' Di�ablad: Yes go X Z! speci=1 ac�ammodations �e needed, please apec��y- Minnesota Mechanical Contractors Association So9 did you heaz sbaut this epeai�g7 i+OY ?� � Oc 1 t; a� TOTA� P.02 g�? 2g8 85t3 pPGE.992 Nc�k TLITPI PAfiF G1R? �kw .�n�-crtvoa t�+•1J DH1P71 !'HUL MH'YUK'O'i fJFFICE �.� vrrt�a va i�ac ru►zux ��gy 39d CT�Y HhLL �V,7 � SAI21x PAIIL, MINNfiSOTA 55102 T 26s-sss6 N�.: _ �.h�e, l L � : �'�1��� fiome eaaress : 2-3 l\ C o .� ,. � c _ - - �Jl.��e Qeov str��t ci�ry Telephone 27umher: �Eio�eZ_ Plsnning Distriet Cv+mcil: 612 26ci 0513 P.02�03 RECEWED � rl�� MAY 2 c 1995 r���i:=°s a��ic�--- -� - -.. ��'C_ . mN, SS/ �a Zip ya6- 96.��_---�°£�- 37`'�-=- /sis� Praferred 2Sai13n� Address; C�Me `__ Vhnt is your oecupacic+u7 � �e� \ 1 � S e f C� 4, f 1 he SS /T� es�.�1 Place'ot �ploymcr�c.: � � � ���,e �I�ST� �a<q,, � � �o J Commi.ttee<s) Appll.ed For: --�.f[1��! - - i..).S?���� - ��� — . - �7�"` - 'T�^el r'f�.eh Ci-r-�R ('�0.S �� \�AS' eY '� S eS G v. __�._.— T_ . ._ � c� � City Cc�c£1 �Tard: C�..�t� �� -�'. C �e`CQ h<<,/ ------ .1 � s� :� . . . _. ,_-- . --- - �-�-�--- .._ _------- T �Jhat akills/training or es do you poasar.� �or the commitcee(s) for vhich pou seek appointmenr.� aS ��f.. .. . � 1G������ .. . __ , . ...--- ._.__. � '-2V� `C 2 __..._.�`d�'VCr-`��.. �L°.L?�,��Ql� --- � �'1Ec ✓ � �L _Cti,af fY�etn..�32.v' � __�_� `� S _._..- - - _._... -- - ---------- - --- ----_ _ _. �owrr2 r+�.�� �AS �W'e� _ ��r_y__i2 ��� `____ ...--- �`�... -,L. �_��'S� �' - ��"....._a�._.__��., ���Y I�re.r�ec�. The in£orc�ation incivded in rhis arplic:ii.i.uu is cvnside.red yriv.«c data sccording t� ehc Hinnesoea Gare�enc Data Tractices Acc. I,s a result, this informacion is not released to thn �aneral public. COVFx) - -- - ---- - - ' Rev.4%21/9 - Addr�aa•���_ Y M1011! : _ t�tau � x,�n� r.�.� �ui��,r. 7 U�9• t4t � o {�es� aS' J cV h b12 266 H513 P.03ic3 _ L ��d�,� r�,�. _ y� , _ /� --.�����: --------- . .� / "[ l Ri� _�"Uh/�t' .._._. _. _-•--- (� 7 jl/ / ._. ._ S . L �`��_....,/..1..!.! .- .. .c.vr,rA) �J(�'}�f.1�'�..�__.�nl �f�i�%, .. ��m, � !� ss,� c �Yy U,r� �� twar.nB• � l � Ve � ,✓ ----"�-�-7�-- j" '� 8 � , .__ ....__.._. Phone; CHeme.),__�J �"",_�- 7 !A 3 1 �___ , T__�Wor , .-----.- ,--s-- -t- rS : -- Name: ���t �,5 t? _h.�4� Te.r" A+�cl �L�C�C�O � n Addrasc• • a . \ . Phoaa: (Home) _ �(� � [Yt- _. _._�._ _. -- -^ -- C -•- =k1�._.._.. L� __.l�1 /�� � -�' ( �`� &assans Poz ynuz incereat 3.n t:63s particular. en�mi_ttee: t v �� 'C� }.� . n _.r. � 1 � 1 _'l.. � 1 V e . w� _�...i. .LaJ � -... •- - -` t� M�(X''� . �_.. . � J V" D , i. � . �....._ -�� � c�v � ,��� _. ..._ � 1.- lLer��>_ �' /-,� -� f ' __.__-----.. .._-- _..__._.._...._--------•--�--��-__ . ._.�—..__...._- ' - Have qoa had prevx�us contec� vit7i rhe coami�xtee for vZlich qou 9re making applicacion. Xf so, vhun, and cSz•citmstax,c�3? _ Z --� � }'` C "y'D V' Zn an a=tempz to easuxe thsc coeami�tee repc•esrYitatiOt7 r.eFlecLS the nakeup of our �ommssnity, please check r.h� Iine anpjyca8le ra yuu. This infar.mation is strictly voltmtery. � Yhite (Caucasian) Hisyanic Black (African American) Asia:� or. Pxcific Sslnader Amazicsn Indixn or Al.askaii Eskimo .� 2tale / / --•..._. Femnlo R.�t�� nf nir17�: �// � / � �.._:-_...__._.__1.._:_ � - Diaahlad: Ye:: � , _ . No V z1' specSa2 accnmmodar.idns arr tiorJr.d, p7.Fasu specify. Hov did you heIIl' abouC ctxis-oycning7 .�� � ��J . � r TOTAL P.�J3