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02/26/2011 1,1145 65'11 E39-9089 FEDEX OFFICE O�61, 6 PAGE, 02
<br />What lis your vises' oif the roils, of this Carr MjSSI()r)/ Board?
<br />1: believe thii all of the. C;0=41slg;:Lc)ns - ftliat- tile, prOVISAP., input f ro*, ard 'Ina,", P.:EtIzeng, t,o
<br />the i goviern:Wg biod-y 111111151111 in this elkaep our City, colmeil on any, event�s, at issuea t,h*t
<br />affect, 'Itbie e0mufttY as a, whole. " Tl e3r provMe. aim appgoictImitypi for, candM debate and
<br />perhaps r8solutlon of! prbiblems ;Ln*a s =ew hot pry emptjLvra, WaY. sio, tbAt the C;oumills
<br />1
<br />Any, further Intormation yov would like the Cky Council to nelder or Mat ymi feel IS reldwant, to the appoIntment or
<br />rGiOPPOinini, you are, seekino,
<br />I by Me ky
<br />I understand thatinfonation PMVWOd In this, apipi�lmdoin may WdWbuted i i c to, the Public, Including, but not
<br />fimitOd tO, b0iling posted on this City Of ROSAW110 vmlbsite. I agree to wailivin a�ny, and all dalting undair the MInrm3satq
<br />Governiniant Dieta Prad�c*s, Adii, or any fter appilkebilb state and fedeimll lawi,, thial -ini any ws�y mlated to the dMmmInation
<br />to, thiol Public of i�nform�ation Oontaln i ni this appillicaflon that vmuld be d2sWed Os PrWita undet swoh laws. I und�eirstand
<br />that I MY Qilct fti respoinsibile stuthorlty f6r uhia rfty of ftckepWjI& if' I haVO any, que�stion�s mgarding ft public or prhmte
<br />nature of the infomimbon provided.iiiiiii"
<br />E
<br />0`002-510nallY ORY Ste' 949S requeSU fmnn the medle or fromi the plublic for wa�ys to, contaroommi inn m m , Offn"On, the, city mayl MI 'aso to Sonne 001MMISSim roster Is pisdodcaly madigi mmilabile. Plate Indlicate which W $8 �ei bi 7h
<br />requefts, It or thiat may big Included Oni the, CommisSIM roider., Und�eir MN Statute one Vft
<br />Or 616amnic rnai'j addraisai (,Or� bDthi ) Whem §12.601. Subid. 3(b),, eMer a telephone
<br />YOU 0811 be, tftdwd miust, two malde ava lable
<br />to the Public. Plaimse, Indlicate at
<br />least on e, phoi numbeir, or ona am�all add�rm�$ to, bei avnlllablo� to, th�e publia balow. MW Orid 1111 In t'hie ccmaPondling Informstiori In Ift
<br />Home Phone plumber
<br />CaN Phone Niurnbw
<br />Work Phone Number r] Preferred Emall Aiddress
<br />Hoim,6 Phoine, —IMMINJi ...... rim
<br />Work Phone (65Z) 6131-012914
<br />Coll phoi 1"rMi JAM, ..... W-111101i
<br />Pmft�' Email Address
<br />Tenineswi WOrning, Somie air al�l of1he Inif militation� Owt
<br />.1
<br />conld&*ial. PH"ite data Is Inb"auon you are SSW to, pm%ide Is aim, by SUh9i low oil% ekhmir pdvatai or
<br />On t 90netdy cannot be ghmin to 111101 Public; bid cani begiveni to the, qu*ct of th�ipi clotgM
<br />Confidenbal data Is Infafmagoin ihxt� genemily, cannot be givani to, wther thei puboj: or, the Subj'ad of th�ei dals.
<br />Thiji Oty, of Pto"Ville is cmfledng the Intrmagoin to deWmInei quellflcaflcm° to beM an a C40MMIfton/Bamod., YOU Sral not, legally
<br />nquilmd t0i PfOvkle thIS 1401rmaVon. Homiver, If you do not s�uipiply, the 1r&mmtkn,1 yNi may fliot 1511 Oni a (:bMmIrAkWAO8rd.,
<br />Oltherl Per is (xM arNes M&Ofted b'Y 16W W reC" th' is Infwmatlon, are C4y, Cndl member SaintarazW Nem. ff, resldft a i %S&jje
<br />nd
<br />Any additlonal Jrft firma oon MO Y be 00mllaidto, llrifo@ldl.rcP3aWlle'.rn�ni.iuls or dell to, AdminimrWon Dj$p*rtrrNqM, City()f
<br />Roseville,i 2660 Civic C�ent@iiri Diylve,i Roseville , IVIN 66113, or faxed to 6$1.7921!, "()30,
<br />1 hfivis Mad and UrKWirstaind the $W(emenw,Oni INS fmims, and I her8by S"ar Or RIM= t* the stat�emerft an this form ars
<br />true. w
<br />2 yes
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