Laserfiche WebLink
City of <br /> Pequ <br /> sakes= <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 <br /> Name A arc g,./ 7 E//er/A9 <br /> ❑ Home Telephone Number <br /> ❑ Home Address <br /> ❑ E-mail Address <br /> ❑ Work Telephone Number <br /> A Cell Phone Number 3 d.C' 7-9/ 9605- <br /> Other <br /> Signature• Date: 5 C9 " <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 Mdmiaistra iantCiry ChdABaaNs and CommtsslonMpplication Process and Fomis\Forn Application Form for Boards and Commiissiom.doc <br /> Page 5 <br />