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GovernmentDataPracticesAct,oranyotherapplicablestateandfederallaw,thatinanywayrelatedtothe <br />disseminationtothepublicofinformationcontainedinthisapplicationthatwouldbeclassifiedasprivateundersuch <br />laws.IunderstandthatImaycontacttheresponsibleauthorityfortheCityofRosevilleifIhaveanyquestionsregarding <br />thepublicorprivatenatureoftheinformationprovided.:Yes <br />OccasionallyCitystaffgetsrequestsfromthemediaorfromthepublicforwaystocontactCommissionmembers.The <br />Commissionrosterisperiodicallymadeavailable.PleaseindicatewhichinformationtheCitymayreleasetosomeone <br />whorequestsitorthatmaybeincludedontheCommissionroster.UnderMNStatute§13.601.subd.3(b),eithera <br />telephoneorelectronicmailaddress(orboth)whereyoucanbereachedmustbemadeavailabletothepublic.Please <br />indicateatleastonephonenumberoroneemailaddresstobeavailabletothepublic,andfillinthecorresponding <br />informationinthebelow.:PreferredEmailAddress <br />HomePhone: <br />WorkPhone: <br />CellPhone: <br />PreferredEmailAddress: <br />Ihavereadandunderstandthestatementsonthisform,andIherebyswearoraffirmthatthestatementsonthisform <br />aretrue.:Yes <br />AdditionalInformation: <br />Formsubmittedon:7/15/201412:52:52PM <br />2 <br /> <br />