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2011_0725_packet
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2011_0725_packet
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2/15/2012 1:34:44 PM
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12/22/2011 10:01:45 AM
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I understand that information provided in this application may be distributed by the City to <br />the public includin , but not limited to, being posted on the City of Roseville webs,ite. I <br />agree to waive any and all claims, under the Minnes,ota Government Data Practices, Act, or any <br />other applicable state and federal law, that in any way related to the dissemination to the <br />public of information contained in this application that would be Classified as private under <br />such laws,. I understand that I may contact the responsible authority for the City of <br />Roseville if I have any questions, regarding the public or private nature of the information <br />provided.: Yes, <br />Occasionally City staff gets, requests, from the media or from the public for ways, to contact <br />Commission members,. The Commission roster is periodically made available. Please indicate <br />which information the City may release to someone who requests, it or that may be included on <br />the Commis ,s,ion roster. Under MN Statute §1,2.601,. s,ubd. 3(b), either a telephone or electronic <br />mail addres,s, (or both) where you can be reached must be made available to the public. Please <br />indicate at least one phone number or one email addres,s, to be available to the public, and <br />fill in the corresponding information in the below.: Work Phone Number, Cell Phone Number, <br />Preferred Email Addres,s, <br />Home Phone : <br />Work Phone : 651,-636-3760 <br />Cell Phone: 61,2-867-091,5 <br />Preferred Email Addres,s,: wa�yine rof'f'oed ina�re�a�l,ty.Corgi <br />I have read and understand the statements, on this form, and I hereby swear or affirm that the <br />statements, on this form are true. : Yes, <br />
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