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2004_0112_Packet
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2004_0112_Packet
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Last modified
5/12/2014 1:06:31 PM
Creation date
12/14/2009 1:39:03 PM
Metadata
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Template:
Roseville City Council
Document Type
Council Agenda/Packets
Meeting Date
1/12/2004
Meeting Type
Regular
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The following information is requested to process your application. <br />Name: <br />Address: <br />�at�rl�#at�l;�,��: <br />Roseville Resident: Years <br />Home Telephone: <br />Home Fax: <br />Home Email: <br />Work Email: <br />Student Applicant <br />Work Telephone: <br />Work Fax: <br />o Yes, Grade <br />o No <br />May we contact you using your work email or fa�? Yes <br />No <br />� <br />
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