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�oseville if I have any questzons z�garding the publ�c or prava�e nature of the <br />infarmation provided.: Yes <br />I unders�and that the City will not publish my phone or fax numbers or email address <br />wi�hout my authorization and da hereby allow the City to publish (check all that apply).; <br />Home telephone number, Wor� telephone number, Work fax number, Home email address, Wark <br />email address <br />Daytime Phone: 65�-484-3813 <br />Evening Phone: 651-484-3813 <br />Cel� Phone: <br />Horne Phone (it dif�erentj: <br />Work Fhane (if dif�erent): 612�721-0657 <br />�ome Fax: <br />Work Fax: 612y�28-1216 <br />Home EmaiT: j.bold�@usfarnzly,net <br />work Email: jeff.boldt�state.mn.us <br />Student Application: N� <br />If yes, please list your gradee <br />May we contact you using your work email or fax?: Yes <br />I have read and understand the state.ments on this form; �nd I hereby swear or affirm tha� <br />the statements on this form are true. : Y�s <br />AdditionaT xntarmation: <br />Form submitted on: 2/Z5/2009 8:2fl:42 PM <br />Submitted from IP Address: <br />Form Address: http://www.ci.roseville.mn.us/forms.asp?�I�=237 <br />� <br />