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IunderstandthatinformationprovidedinthisapplicationmaybedistributedbytheCitytothepublicincluding,butnot <br />limitedto,beingpostedontheCityofRosevillewebsite.IagreetowaiveanyandallclaimsundertheMinnesota <br />GovernmentDataPracticesAct,oranyotherapplicablestateandfederallaw,thatinanywayrelatedtothe <br />disseminationtothepublicofinformationcontainedinthisapplicationthatwouldbeclassifiedasprivateundersuch <br />laws.IunderstandthatImaycontacttheresponsibleauthorityfortheCityofRosevilleifIhaveanyquestionsregarding <br />thepublicorprivatenatureoftheinformationprovided.:Yes <br />OccasionallyCitystaffgetsrequestsfromthemediaorfromthepublicforwaystocontactCommissionmembers.The <br />Commissionrosterisperiodicalymadeavailable.PleaseindicatewhichinformationtheCitymayreleasetosomeone <br />whorequestsitorthatmaybeincludedontheCommissionroster.UnderMNStatute§12.601.subd.3(b),eithera <br />telephoneorelectronicmailaddress(orboth)whereyoucanbereachedmustbemadeavailabletothepublic.Please <br />indicateatleastonephonenumberoroneemailaddresstobeavailabletothepublic,andfillinthecorresponding <br />informationinthebelow.:HomePhoneNumber <br />HomePhone: <br />WorkPhone: <br />CellPhone: <br />PreferredEmailAddress: <br />Ihavereadandunderstandthestatementsonthisform,andIherebyswearoraffirmthatthestatementsonthisform <br />aretrue.:Yes <br />ormation: <br />AdditionalInf <br />Formsubmittedon:9/20/20128:54:14PM <br />2 <br /> <br />