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PR,_Kamr rath <br />I understand that the city will not publish m�y phone or fax numbers or e�m�ail <br />address without m�y authorization and do hereby allow the city to publish <br />(check all that apply).: Home e�m�ail address <br />Daytime Phone: <br />Evening Phone: <br />Cell Phone: <br />Home Phone (if di f f e rent) <br />work Phone (if different): <br />Home Fax: <br />work Fax: <br />Home Em�ai 1 m�arkam�m�i e m�sn. com <br />work Em�ail: <br />Student Application: No <br />If ye�s, please list your grade : <br />May we contact you using your work em�ail or fax?: No <br />I have read and uncle rstand the statements on this form , and I he re�by swear or <br />affirm that the statements on this form are true. : Yes <br />Additional Information: <br />Form subm�itted on: 2/16/2010 10:07':26 Pm <br />@ � 5, <br />