Laserfiche WebLink
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§13.601.subd.3(b),eithera <br />telephoneorelectronicmailaddress(orboth)whereyoucanbereachedmustbemadeavailabletothepublic.Please <br />indicateatleastonephonenumberoroneemailaddresstobeavailabletothepublic,andfillinthecorresponding <br />informationinthebelow.:CellPhoneNumber <br />HomePhone: <br />WorkPhone: <br />CellPhone: <br />PreferredEmailAddress <br />dunderstandthestatementsonthisform,andIherebyswearoraffirmthatthestatementsonthisform <br />Ihavereadan <br />aretrue.:Yes <br />AdditionalInformation: <br />Formsubmittedon:7/10/20134:30:10PM <br />2 <br /> <br />