Laserfiche WebLink
D�yti.me Telephone: � <br />�ven?ng Telephone: 653-488-2498 <br />Home Telephone (if di�ferent}: <br />G;ork Telenhone (if different) : <br />home Fax: <br />wark Fax: <br />Hame Err�a i 3 : <br />U;ork Emai1: <br />�,.� � ��-: � <br />� <br />Nay w� co�tac�. you using your vaork emaal or fax?: Yes <br />T have read and. understan.d the statements on �his form, and � hereby swear or affirm that <br />the statements on this form are true. : Yes <br />Additional Inform�tion: <br />�'orm submztted on: 9/10/2009 4:47:53 PI�i <br />Submitted fram �P Address: <br />Form Adaress: http://wvrw.ci.rosevilTe.mn:us/forms.aspx?FiD=251 <br />Confiden�.iality Statement: The docutrrents accompanying �his transmassion contain <br />canfidential intormation tha� is legalTy privileged. This information is intended nnly <br />for the use of the individuals or entities listecl above: Tf you are not the intendec] <br />recapaent, you are hereby notified that any disc�osure, copying, distribution, o�' action <br />taken in reliance an the c`ontents of tl-aese documents is strictly prohibit�c3. If you have <br />received this information in error, please notify the sender immec�iately and arrange for <br />the return or destructian �f th.ese documents. <br />z <br />