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� � �� � <br />www.ci.roseville.mn.us <br />City of Roseville o 2660 Civic Center Dnve. Roseville MN 55113 <br />Phone: 651.490.2206 + Fax: 651.490.2276 <br />Application for Citizen Advisory Commission <br />Please check commission applyingfr�r: <br />❑ Ethics Commission <br />❑ Grass Lakes Water Management Organization <br />❑ Human Rights Commission <br />❑ Park and Recreation Commission <br />❑ Planning Commission <br />� Police Civil Service Commission <br />❑ Community Committee/'Task Force(name) <br />� <br />Name: � � r��e r� � �� � � <br />Address: �� .� ,� �� � � �?�J� �r.� �r� <br />Student � N� <br />Applicant U Yes, Grade <br />Roseville <br />City/State/Zip _ � .� ��� � � � . %%7�v � s� [_t� Resident '�� Years <br />, <br />Telephone: (Home) � � � ����� — / 0 � �% (Work) f� � � t cF �}� _ ,F�i 3 3 <br />Email: <br />Fax• & i t - � � �# - 7� �.-�i <br />1�i{oric E�pearie,�c�e: ��� �a����t_ ���+��� o � �� �r�c3 <br />��r�.� � �?�� r� � ����.# �r� ���t rs� i� c�` -- <br />F-�u�ai�a: _.��� i �fF��Vl� T��.�L�� � <br />�.i+ric �a� V�L�at� ��fi�itisa: �� � �res��} �,� r� c� c,���r��� <br />+��rr'�� n �t � { 4 , ' <br />