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--eb 28 11 04:25p, D Nelson <br />1 -631 -9453 p.2 <br />Page 2 oil <br />I undemiand that Information provided In this application miay, be distributed by the City to the pW[c <br />ineWdingi, "i not limited to, being posW on the City, of loo mvilievimbsite. I agree,to waive an,y,and alll <br />clalims under the Mimes�ota Govemnwt Data Practices A&, or any other appliMble State and federal law, <br />t,hiiat in any way reiated W the d1surdnabion to ft puNic of informationi wntained In this aippilication Ow <br />wotAd be classMed M private under such lam, I uncMirsta,n�d that I may carrtwl the responsibte aLthori'ty for <br />the City of RosevOle ff I have any q ns regarding the, public or private in tune of the irformation <br />.preivided.* <br />Cen Phone, <br />PreferrW Em all Address 4;:O_kj_.COo_jO <br />t. <br />of& CO A# 011% 41 <br />Tennessen WarNng.-' Some air all of I Allmaboni that you are as,ke to Provide is dassified by State law, asi ekher <br />pitivale or can Mental. Private daW is 1riformatior th8t _ rfcA be given to the publl ir., biut Can be -given to the <br />auNed of Um daita. Confideftal dMai Is inftmation that gener011y C3nMW be given r Me public or ft subject of the <br />data., <br />Submit ul rrk an�d I Re" j [-an- <br />Gel <br />Powered by CivicMus t Copyright Natkes Site Mop I Disclaimer, I Privacy Policy 1 2660 Civic C'enter Prive, Pkw4ville, MN Wila 165,1-"2-71)0101 <br />hftp.-/Iwww.r,ityofroseville.com/forrns.asipx'.?fid=23 7 1/24/201,1 <br />