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understand that I may co�a.tact the responsible authority for the City of Rasevz��� if I have any questions <br />regardin� the public or private nature of the ixa£o�x�atio� provided. <br />I understand t�zat the City will i�ot publish rny phone or fax numbers or e�aaal address without my authorization <br />and do hereby allow the City to publish (check aJ� that apply). <br />��oz�e telephone number w o r k telephone number otl�e� telephone number <br />home fax number work fax number <br />X home �za.aai� adciress work ezx�a�i address <br />� ��II�,� ���-�� � ��- �� <br />Signature of Applicant Date of Application <br />Application061129 <br />