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needs of its residents are taken care of. Any further informatian. you would like the City Council to consider o� �hat you feel is relevant to the appointment you are seeking.: I want to help give something back to the community where z now ca11 my home. I understand that aIl information provided in this application, except my telepnone nurnl�er,. fax number and email address, may be distributed by the City to the public including, but not limited to, being posted on the City of Roseville websit�. I agree to waive any and all claims under the Minnesata Government Data Practices Act, ar any other app�icable state and federa� law, that in any way related to the dissernination to the publi� of information contained in this application that would be classified as private under such laws.. � understand that x may contact the responsible authority for the City of Roseville if I have any questions regarding the public or private nature af �he information provided.: Yes I understand that the City will not publish my phone or fax numbers or email address wi�hout my authorization and do hereby allow the City to publish (check all that apply).: not chec�ed Daytime Phone: Evening Phone: Cell Phone: Home Phone (if aifferent): Wark Phone (if d�fferen�}: Hame Fax: Wor� �ax: Home Email: Work Emai�: Student Application: �o If yes; please list your grade: May we contact you using your wor� email or fax�: Yes I ha�e read and und�rstand th� statements on this form, and � hereby swear ar affirm that the statements on th.is form are true. : Xes Additional Informatian: Form submitCed on: 2/27/20d9 2:50:36 PM 5ubmitted fr�m IP Address: Form �ddress: http://www.ci.roseville.mn.us/forms.asp?FID=237 2