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HR—Brisbois txt I uncle rstand that inform�ation provideed in this application ray be distribused by the city to the public including, but not lim�iteed to, being posted on the City of Roseville we�bsite . I agrree to waive any and all claims under the Minnesota Governm�ent Data Practices Act, or any oche r applicable state and federal law, that in any way related to the dissem�ination to the public of inform�ation contained in this application that would be classified as private under such laws. I understand that I ray contact the responsible authority for the City of Roseville if I have any questions re�garding the public or private nature of the inform�ation provided.: Yes occasionally city staff gets requests from the media or from the public for ways to contact Commission members . The Commission roster is periodi cal y made available. Please indicate which inform�ation the city ray release to someone who requests it or that ray be included on the Commission roster. Under MAN statute §12.601. subd. 3,(b), e�ithe r a telephone or e�le�ctronic m�ail address (or both) where you can be reached rust be made available to the public. Please indicate at least one phone number or one em�ail address to be available to the public, and fill in the corresponding inform�ation in the below.: Cell Phone Number Cell Phone: 651-23,5-223,8 Pre�fe rre�d Em�ail Address: j'illbrisbois@,gm�ail.com I have read and uncle rstand the statements on this form , and I he re�by swear or affirm that the statements on this form are true. : Yes Additional Information: Form subm�itted on: 1/13,/2011 7':50:29 Pm @ � I,