Laserfiche WebLink
City of <br /> Peqyot <br /> akes <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. JJ <br /> El Board and Commission \\OV ✓y 9,beveA <br /> ❑ Name St (Am `(�� t\p` <br /> ❑ Home Telephone Number Li It ni A Vi tog <br /> ❑ Home Address 1 TA L CL S((AL <br /> tc►or C.c (4I M M 5 t 2.- <br /> ❑ E-mail Address g k A &Li toomop414- t Qnn A t t w <br /> ❑ Work Telephone Number <br /> ❑ Cell Phone Number <br /> ❑ Other <br /> Signature: 1,t i#. 71 Date: 11-1 <br /> 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 /> SMdmim tration\City Clerk\Boards and Commisaims\Application Process ami Forms\Fotms\Applicaticn Form for Boards and Commissions.doc <br /> Page 5 <br />