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Any further information you would like the City Council to consider or that you feel is relevant to the <br /> appointment or reappointment you are seeping.: I feel that consistency and background of what has taken place <br /> the last year or two is very advantageous, and I would be honored to continue serving on this commission. <br /> Thank you. <br /> I understand that information provided in this application may be distributed by the City to the public including, <br /> but not limited to, being posted on the City of Roseville website. I agree to waive any and all claims under the <br /> Minnesota Governinent Data Practices Act, or any other applicable state and federal law, that in any way related <br /> to the dissemination to the public of information contained in this application that would be classified as private <br /> under such laws. I understand that I may contact the responsible authority for the City of loseville if I have any <br /> questions regarding the public or private nature of the information provided.. Yes <br /> Occasionally City staff gets requests from the media or from the public for ways to contact Commission <br /> members. The Commission roster is perlodlcaly made available. Please indicate which information the City <br /> may release to someone who requests it or that may be included on the Commission roster. Under MN Statute <br /> 12.60 1«Ρ subd. 3(b), either a telephone or electronic mail address (or both) where you can be reached must be <br /> made available to the public. Please indicate at least one phone number or one email address to be available to <br /> the public, and fill in the corresponding information in the below.: Preferred Ismail Address <br /> Horne Phone : <br /> Work Phone M <br /> Cell Phone: <br /> Preferred Ismail Address: mpUs.holt5@gmail.com <br /> I have read and understand the statements on this form, and I hereby swear or affirm that the statements on this <br /> form are true. : Yes <br /> Additional Information: <br /> Form submitted on: 12/15/20117:231-634 P <br /> Submitted from IP Address: <br /> Referrer Page:No Referrer- Direct Link <br /> Form Address: h,gp://www.cityofroseville.com/Fonns.ast)x?FID=237 <br /> 2 <br />