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Minnesota Govermnent Data Practices Act, or any other applicable state and federal law,that in any way related to the dissemination to the public of information contained in this application that would be classified as private under such laws. I understand that I may contact the responsible authority for the City of Roseville if I have any questions regarding the public or private nature of the information provided.: Yes Occasionally City staff gets requests from the media or from the public for ways to contact Commission members. The Commission roster is periodicaly nude available. Please 'indicate which information the City may release to someone who requests it or that may be included on the Commission roster. Under MN Statute 12.601. subd. (b), either a telephone or electronic mail address (or both) where you can be reached must be made available to the public. Please indicate at least one phone number or one email address to be available to the public, and fill in the corresponding information in the below.: Home Phone Number Horne Phone : 651297 0229 Work Phone Cell Phone: Preferred Email Address: rnrfj elstad@aol.com I have read and understand the statements on this form, and I hereby swear or affirm that the statements on this form are trine. : Yes Additional Information: Form submitted on: 12/15/2011 8:3 : 3 PM Submitted from IP Address: Referrer Page: htt -,//mail.aol.cony/3 138-111/aol-6/en- us ite/Msgl ead.asp ?folder=l ewMaii uid=26893 964 seq=o b triplma esFromThis enderlfLJnknown=fal se b tri Lin sFromThi s enderIf Unknown=false b d.d Contact=false Form Address: hU://www.cilyofrosev'ille.com/Fortns.aspx?FID=237 2