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I understand that all information provided in this application, except my telephone numbers, fax number and <br />email address, may be distributedby the City to the public including, but not limited to, being posted on the <br />City of Roseville website. I agree to waive any and all claims under the Minnesota Government Data <br />Practices Act, or any other applicable state and federal law, that in any way related to the dissemination to the <br />public of information contained in this application that would be classified as private under such laws. I <br />understand that I may contact the responsible authority for the City of Roseville if I have any questions <br />regarding the public or private nature of the information provided. <br />I understand that the City will not publish my phone or fax numbers or email address without my authorization <br />and do hereby allow the City to publish (check all that apply). <br />_X home telephone number X work telephone number <br />—X home fax number —X—work fax number <br />X home email. address X work email address <br />of Appkmt <br />�fwkoamcffirl <br />—X —other telephone number <br />EFWMMOF,W <br />