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I understand that information provided in this application may be distributed by the City to the public including, but not limited to,being posted on the City of Roseville website. I agree to waive any and all claims under the Minnesota Government 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 an 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 perlodicaly made available. Please indicate which information the City may release to someone who requests it or that may be included on the Commission raster. Under 1N 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,Preferred Email Address Home Phone : 651-645-6161 Work Phone : Cell Phone: Preferred Email Address: ggefenberg_(2komcast.net I have read and understand the statements on this form, and I hereby swear or affirm that the statements on this form are true. : Yes Additional Information: Form submitted on: 12/15/20114:20:13 P11 Submitted from IP Address: Deferrer Page:No Referrer- Direct Link Form Address: h :/1ww .ci ofrosevi'lle.com/Forms.as ?FID=237 2-