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City of <br /> Pequ <br /> DATA RELEASE FORM <br /> In accordance with the Minnesota Government Data Practices Act,the City of Pequot <br /> Lakes is required to receive your consent before releasing any information about you that <br /> is classified as private data.Private data is information that is not available to the public. <br /> If appointed to an Advisory Commission or elected as a City Official,I authorize the <br /> City of Pequot Lakes to disclose the following information.You must choose at least <br /> one phone number or e-mail address to be made public. <br /> • Board and Commission Planning Commission <br /> ❑ Name <br /> ❑ Home Telephone Number <br /> ❑ Home Address <br /> ❑ E-mail Address <br /> O Work Telephone Number <br /> ,Of Cell Phone Number (21i0 2_ <br /> O Other <br /> Signature: -1:2-1c: Date: i to(2-1 <br /> This release will be in effect as long as you serve on the Board,Commission, <br /> Council,or Task Force and can be changed upon your request at any time. <br /> S:\Adm n City ClerldRoards and CammissiorelApplication Process and FormsTmms\Application Form for Boards and Cmamissionadoc <br /> Page 5 <br />