Item 1. Commissioner Applications13400 90th Street NE, MN 55330
763-441-4414 1 www.ci.otsego.mn.us
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OtSCITY eF O
MINNESOTA
Council Advisory Commission
Application,City
• / Release
Name Phone
Dan Freiberg 7637725368
Street Address City
State
Zip
12577 96th st ne Otsego
MN
55330
Email address
Number of years/months resident of Otsego
danandsharifreiberg@gmail.com
31
Please list any special interests or training you have that could benefit a particular Board or Commission (attach a separate sheet if necessary).
Current commission member
Current MN police officer/paramedic
Bachelor Degree in law enforcement
AAS degree in paramedicine
Please number your choices according to preference:
Heritage Preservation Commission
Planning Commission
Parks and Recreation Commission
✓ Public Safety Commission
Important Information About Your Application
Data Privacy Notice: Minnesota law requires that you be informed not legally required, but refusal to supply the information request -
of the purpose and intended use of the information you are provid- ed may affectthe City Council's abilityto accurately evaluate your
ingon this application. Per Minnesota Statute 13.601, subd. 3a, your application.
name, address, length of residence, occupation, education, training,
civic affiliations, qualifications, experience, and veteran status are Should you be appointed to a City of Otsego public data and
available to anyone who requests the information. Commission, your residential address and either a phone number
or email address where you can be reached will also become public
This information will be used to identify you as an applicant, enable information (per Minnesota Statute 13.601, subd. 3b). The purpose
us to contact you when additional information is required, send you is to list contact information for Board/Commission members on a
notices, and assess your qualifications for appointment. This data is public roster.
Please select which of the following you will allow listed on a public roster (you must select either email or phone number).
RJemail ❑phone 1:1 both
Signature
Date 01 /05/2021
Email Completed Applications to: bbenting@ci.otsego.mn.us
Email Completed Applications to: bbenting@ci.otsego.mn.us
13400 9011' Street NE, MN 55330
763-441-4414 1 www.ci.otsego.mn.us
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Council Advisory • •
Application • / Release
Name
Phone�H)
Street Address
/4 L' C-1
City
els'2a 61
State
Zip
Email addressh��rsoh /5
Number of years/months resident of Otsego
Please list any sp al i -rests or training you have that could benefit
a particular Board or Comm ssion (attach a separate sheet if necessary).
c��er/���� CS'e-rl�P�/' d� Oh�/"�
%d � /,5'�� y��✓-S��
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Gcvn 5'Glo✓
Please number your choices according to preference:
�f L lJ
Heritage Preservation Commission
Planning Commission
Parks and Recreation Commission
Public Safety Commission
Important Information About Your Application
Data Privacy Notice: Minnesota law requires that you be informed
not legally required, but refusal to supply the information request-
of the purpose and intended use of the information you are provid-
ed may affectthe City Council's ability to accurately evaluate your
ing on this application. Per Minnesota Statute 13.601, subd. 3a, your
application.
name, address, length of residence, occupation, education, training,
civic affiliations, qualifications, experience, and veteran status are
Should you be appointed to a City of Otsego public data and
available to anyone who requests the information.
Commission, your residential address and either a phone number
or email address where you can be reached will also become public
This information will be used to identify you as an applicant, enable
information (per Minnesota Statute 13.601, subd. 3b). The purpose
us to contact you when additional information is required, send you
is to list contact information for Board/Commission members on a
notices, and assess your qualifications for appointment. This data is
public roster.
Please select which of the following you will allow listed on a public roster (you must select either email or phone number).
am all ❑phone El both
Signature
Date
Email Completed Applications to: bbenting@ci.otsego.mn.us
13400 90th Street NE, MN 55330
763-441-4414 1 www.ci.otsego.mn.us
nom_,"
2
ameO
Name—T&,11
l/L,1l (� �e�O ��Q Phone ?6 3 LK 3 06 9S
Street Address `ow ,< _ ( (er f�
Cit01_15e4e
State
zip
Email address GOv►n
Numberof ears/months resident of Otsego+e�OsG�
l
Please list any special interests or training you have that could benefit a particular Board or Commission (attach a separate sheet if necessary).
ea- %A� mss . _T
OuA avi C-L/Ci `,"t G��
Please number your choices according to preference:
Heritage Preservation Commission
Planning Commission
Parks and Recreation Commission
Public Safety Commission
Important Information About Your Application
Data Privacy Notice: Minnesota law requiresthatyou be informed not legally required, but refusal to supply the information request -
of the purpose and intended use of the information you are provid- ed may affect the City Council's ability to accurately evaluate your
ing on this application. Per Minnesota Statute 13.601, subd. 3a, your application.
name, address, length of residence, occupation, education, training,
civic affiliations, qualifications, experience, and veteran status are Should you be appointed to a City of Otsego public data and
available to anyone who requests the information. Commission, your residential address and either a phone number
or email address where you can be reached will also become public
This information will be used to identify you as an applicant, enable information (per Minnesota Statute 13.601, subd. 3b). The purpose
us to contact you when additional information is required, send you is to list contact information for Board/Commission members on a
notices, and assess your qualifications for appointment. This data is public roster.
Please select which of the following you will allow listed on a public roster (you must select either email or phone number).
mail ❑phone El both
Signature
Date
Email Completed Applications to: bbenting@ci.otsego.mn.us
11
13400 901h Street NE, MN 55330 0
763-441-4414 1 www.ci.otsego.mn.us `OF
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MINNESOTA
CouncilCity Advisory •
Application •
Name 1 / Phone _
Street Ad/rens � � N S � City State Zip
�.� L �
Email address Number ofyea s/months resident of Otsego
Please list any special interests or training you ha that could benefit a particular Board or Commission (attach a separate shee if necessary).
G
Please number your choices according to preference:
Heritage Preservation Commission
Planning Commission
Parks and Recreation Commission
Public Safety Commission
Important Information About Your Application
Data Privacy Notice: Minnesota law requires that you be informed not legally required, but refusal to supply the information request -
of the purpose and intended use of the information you are provid- ed may affect the City Council's ability to accurately evaluateyour
ingon this application. Per Minnesota Statute 13.601, subd. 3a, your application.
name, address, length of residence, occupation, education, training,
civic affiliations, qualifications, experience, and veteran status are Should you be appointed to a City of Otsego public data and
available to anyone who requests the information. Commission, your residential address and either a phone number
or email address where you can be reached will also become public
This information will be used to identify you as an applicant, enable information (per Minnesota Statute 13.601, subd. 3b). The purpose
us to contact you when additional information is required, send you is to list contact information for Board/Commission members on a
notices, and assess your qualifications for appointment. This data is public roster.
Pleas .select which of the following you will allow listed on a public roster (you must select either email or phone number).
mail ,❑phone ❑both
Signatu n \ Date
-LIP 14
Email Completed Applications to: bbenting@ci.otsego.mn.us
13400 901h Street NE, MN 55330
763-441-4414 1 www.ci.otsego.mn.us �tkzo`
MIXNESO TA
CouncilCity Advisory • •
Application • • Release
Name R Phone
Street Address City State i
' k i N&7Z) MA vc E z�7'sr,�,o M At
Email addressNumber of years/months resident of Otsego
-po.mrn, e i,L t -r, a �o�, GO cn-Ti_k)6C. /q' .' - euils
Pleale list any special interests or training you have that could benefit a particular Board or Commission (attach a separate sheet if necessary).
-t- he -(d a-vet�y-,-broke-'S la �e.u^s,c40CA!5( 13r�Ma--/ -R(Ofet OI
�ny c�ttnvn�re al but l'143. ,v low t,�co me mera con (�. � � T- �c,n '_ -Lmz etr W,�441, 1tases . S-ince-
-r0n • 61- ?i "pt;�q C 2 C��. 2Cot - 2,_50•2_
of AM, G Ag-s-�Yta-tea �s� � �� A a �_-r. T ca_�u c�inw� ��! ko
A111 VD (1)
Please number your choices according to preference:
Heritage Preservation Commission
Planning Commission pr-) 5 '?)ce- 200/
Parks and Recreation Commission
Public Safety Commission
Important Information About Your Application
Data Privacy Notice: Minnesota law requires that you be informed not legally required, but refusal to supplythe information request -
of the purpose and intended use of the information you are provid- ed may affectthe City Council's ability to accurately evaluateyour
ing on this application. Per Minnesota Statute 13.601, subd. 3a, your application.
name, address, length of residence, occupation, education, training,
civic affiliations, qualifications, experience, and veteran status are Should you be appointed to a City of Otsego public data and
available to anyone who requests the information. Commission, your residential address and either a phone number
or email address where you can be reached will also become public
This information will be used to identify you as an applicant, enable information (per Minnesota Statute 13.601, subd. 3b). The purpose
us to contact you when additional information is required, send you is to list contact information for Board/Commission members on a
notices, and assess your qualifications for appointment. This data is public roster.
Please select which of the following you will allow listed on a public roster (you must select either email or phone number).
mail phone 1:1 both
Signatre Date
A,4�t_ 1114L&I aa/L4_� / /fl_ 0_ �
Email Completed Applications to: bbenting@ci.otsego.mn.us
13400 90th Street NE, MN 55330
763-441-4414 1 www.ci.otsego.mn.us
nJ_^7 T_,- F,
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Name
Phone
Corey Tanner
763-447-1553
Street Address
City
State
Zip
7952 Palmgren Avenue NE
Otsego
MN
55330
Email address
Number of years/months resident of Otsego
corey.tanner74@gmail.com
15
Please list any special interests or training you have that could benefit a particular Board or Commission (attach a separate sheet if necessary).
CMI Service:
1) 3 years on Park and Rec. Commission, 2 of Nose years ware as Vice -Char.
2) 4 years on City Coundl.
3)4 years as Vice Chair of local Economlc Development AuNodty (EDA) ter Otsego.
4) 2 years as Liaison far Otsego Heritage Preservation Commission.
Cmissim.
5) 2 years as'le.- for Otsego Pudic We*, Subom
6) Appofnled to a task force by Wright County to delermine 8 the county needs an EDA.
])Appointed io Wright County PI -1, Board, 2021-2024.
8) Cunenl member acrd advocate for Elder Voie Family Advocates (Senior arms).
9) Member of Otsego 251A Mrd—y Committee.
10) 4 years as a member of I-94 Coalition.
Ed—tion
1) Current Sophomore at Liberty Uni—Ity, N MMINir for Public W Business Admirdkmtio,.(2019-Cunenl)
2) Hard, UnNarsily-ArdNilacbral orb CMI Design. (20002002)
3) Bismarck Slate Unlversity-Energy Technology. (2(10&2011)
Employment & Experience:
l�
1) 11* years -Senior El.tHeal Overhead Transmission LNe Negne0echNdan at Great River Energy. (Elk RiuerlAfap:e Grose)
Please number your choices according to preference:
4 Heritage Preservation Commission
1 V( Planning Commission
2 V( Parks and Recreation Commission
3 V" Public Safety Commission
Important Information About Your Application
Data Privacy Notice: Minnesota law requires that you be informed not legally required, but refusal to supplythe information request-
ofthe purpose and intended use ofthe information you are provid- ed mayaffectthe CityCouncil's abilityto accurately evaluate your
ing on this application. Per Minnesota Statute 13.601, subd. 3a, your application.
name, address, length of residence, occupation, education, training,
civic affiliations, qualifications, experience, and veteran status are Should you be appointed to a City of Otsego public data and
available to anyone who requests the information. Commission, your residential address and either a phone number
or email address where you can be reached will also become public
This information will be used to identify you as an applicant, enable information (per Minnesota Statute 13.601, subd. 3b). The purpose
us to contact you when additional information is required, send you is to list contact information for Board/Commission members on a
notices, and assess your qualifications for appointment. This data is public roster.
Please select which of the following you will allow listed on a public roster (you must select either email or phone number).
Zlemall ❑phone 1:1 both
Signature
Date
U
Email Completed Applications to: bbenting@ci.otsego.mn.us
13400 90th Street NE, MN 55330
763-441-4414 1 www.ci.otsego.mn.us
11
0tCITY o
MINNESOTA
Advisory'City Council
Application • / Release
Name
Phone
Jim Breitbach
612-710-0119
Street Address
City
State
IMN
Zip
8248 Parell Ave. N.E.
Otsego
55330
Email address
Number of years/months resident of Otsego
jebreit@hotmail.com orjim.breitbach@centerpointenergy.com
20 years
Please list any special interests or training you have that could benefit a particular Board or Commission (attach a separate sheet if necessary).
1.) 1 have served on this commission for 2 terms previously and would like to continue and serve the
community of Otsego as we continue to grow and I know that public safety will continue to be an important
topic.
2.) Attended and completed the Citizens academy put on by the Wright County Sheriffs Department.
Please number your choices according to preference:
Heritage Preservation Commission
Planning Commission
Parks and Recreation Commission
Public Safety Commission
Important Information About Your Application
Data Privacy Notice: Minnesota law requires that you be informed not legally required, but refusal to supplythe information request -
of the purpose and intended use of the information you are provid- ed may affectthe City Council's abilityto accurately evaluateyour
ing on this application. Per Minnesota Statute 13.601, subd. 3a, your application.
name, address, length of residence, occupation, education, training,
civic affiliations, qualifications, experience, and veteran status are Should you be appointed to a City of Otsego public data and
available to anyone who requests the information. Commission, your residential address and either a phone number
or email address where you can be reached will also become public
This information will be used to identify you as an applicant, enable information (per Minnesota Statute 13.601, subd. 3b). The purpose
us to contact you when additional information is required, send you is to list contact information for Board/Commission members on a
notices, and assess your qualifications for appointment. This data is public roster.
Please select which of the following you will allow listed on a public roster (you must select either email or phone number).
mail phone 1:1 both
l28yJim ltbach
Signature Digitally
Jim BreitbachDig001.0 B5
Date
1/4/21
-06'00'
Email Completed Applications to: bbenting@ci.otsego.mn.us
• •Itor,141911 I Item
Name Phone
Jason Warehime 763-238-6163
Street Address Cit State Zip
9149 Page Ave. NE Otsego MN 55330
Email address Number of years/months resident of Otsego
warehimej@gmail.com 19 years
Please list any special interests or training you have that could benefit a particular Board or Commission (attach a separate sheet if necessary).
have background in Law enforcement, firefighting, Previously served on the public safety commission
prior to being the laison to the commission for 8 years.
Please number your choices according to preference:
Heritage Preservation Commission
Planning Commission
Parks and Recreation Commission
✓ Public Safety Commission
Important Information About Your Application
Data Privacy Notice: Minnesota law requires that you be informed not legally required, but refusal to supply the information request-
of the purpose and intended use of the information you are provid- ed may affectthe City Council's ability to accurately evaluate your
ing on this application. Per Minnesota Statute 13.601, subd. 3a, your application.
name, address, length of residence, occupation, education, training,
civic affiliations, qualifications, experience, and veteran status are Should you be appointed to a City of Otsego public data and
available to anyone who requests the information. Commission, your residential address and either a phone number
or email address where you can be reached will also become public
This information will be used to identify you as an applicant, enable information (per Minnesota Statute 13.601, subd. 3b). The purpose
us to contact you when additional information is required, send you is to list contact information for Board/Commission members on a
notices, and assess your qualifications for appointment. This data is public roster.
Please select which of the following you will allow listed on a public roster (you must select either email or phone number).
remail phone both
Sliiggn�Date 1/15/21
Email Completed Applications to: bbenting@ci.otsego.mn.us
13400 901h Street NE, MN 55330 1)
763-441-4414 1 www.d.otsego.mmus OtkzoF
MINNESOTA
CouncilCity Advisory • •
Application • Release
Name Phone
Alan Offerman 763-234-5250
Street Address City State Zip
10330 74th St. NE Otsego IMN 155301
Email address Number of years/months resident of Otsego
alanofferman@gmail.com 6 years / 4 months
Please list any special interests or training you have that could benefit a particular Board or Commission (attach a separate sheet if necessary).
I have served on the planning commision for several years and I am a registered professional civil
engineer for my day job.
Please number your choices according to preference:
Heritage Preservation Commission
Planning Commission
Parks and Recreation Commission
Public Safety Commission
Important Information About Your Application
Data Privacy Notice: Minnesota law requires thatyou be informed not legally required, but refusal tosupplythe information request-
of the purpose and intended use of the information you are provid- ed may affectthe City Council's abilityto accurately evaluateyour
ing on this application. Per Minnesota Statute 13.601, subd. 3a, your application.
name, address, length of residence, occupation, education, training,
civic affiliations, qualifications, experience, and veteran status are Should you be appointed to a City of Otsego public data and
available to anyone who requests the information. Commission, your residential address and either a phone number
or email address where you can be reached will also become public
This information will be used to identify you as an applicant, enable information (per Minnesota Statute 13.601, subd. 3b). The purpose
us to contact you when additional information is required, send you is to list contact information for Board/Commission members on a
notices, and assess your qualifications for appointment. This data is public roster.
Please select which of the following you will allow listed on a public roster (you must select either email or phone number).
mail ❑phone both
Signature Date 1/4/20
Email Completed Applications to: bbenting@ci.otsego.mn.us
13400 901h Street NE, MN 55330 C1)
763-441-4414 1 www.ci.otsego.mn.us 0t-s F go
MINNESOTA
ApplicationCity Council Advisory Commission
, Release
Name Phone
Mark Wolf 612-910-2515
Street Address City State F55330
16581 58th Street NE Otsego MN
Email address Number of years/months resident of Otsego
markwolf@centurylink.net 20 years & 7 months
Please list any special interests or training you have that could benefit a particular Board or Commission (attach a separate sheet if necessary).
I worked with the State of Minnesota DNR and the Cass County Land Commissioner to establish an ATV
trail system near Backus MN. I am a former ATV Safety training instructor.
I am a former First Responder.
I have an interest in keeping the community safe for future generations.
Please number your choices according to preference:
Heritage Preservation Commission
Planning Commission
Parks and Recreation Commission
Public Safety Commission
Important Information About Your Application
Data Privacy Notice: Minnesota law requires thatyou be informed not legally required, but refusal to supplythe information request-
of the purpose and intended use of the information you are provid- ed may affectthe CityCouncil's abilityto accurately evaluate your
ing on this application. Per Minnesota Statute 13.601, subd. 3a, your application.
name, address, length of residence, occupation, education, training,
civic affiliations, qualifications, experience, and veteran status are Should you be appointed to a City of Otsego public data and
available to anyone who requests the information. Commission, your residential address and either a phone number
or email address where you can be reached will also become public
This information will be used to identify you as an applicant, enable information (per Minnesota Statute 13.601, subd. 3b). The purpose
us to contact you when additional information is required, send you is to list contact information for Board/Commission members on a
notices, and assess your qualifications for appointment. This data is public roster.
Please select which of the following you will allow listed on a public roster (you must select either email or phone number).
Zlemail ❑phone El both
Signature Mark Wo If Digitally signed by Mark Wolf Date
Date: 2021.01.13 21:26:06
-06'00'
Email Completed Applications to: bbenting@ci.otsego.mn.us
13400 90th Street NE, MN 55330 040
763-441-4414 www.ci.otsego.mn.us TY OF
ot�2'O
MINNESOTA
City Council Advisory Commission
Application and Release
Name Phone
Angie Dehn 612-860-1565
Street Address City State Zip
7820 Padgett Ave NE Otsego IMN 55330
Email address Number of years/months resident of Otsego
jedinak10@hotmail.com 14 years
Please list any special interests or training you have that could benefit a particular Board or Commission (attach a separate sheet if necessary).
I have a Bachelors in Recreation, Parks and Leisure Studies from the University of Minnesota. I have been
working in recreation since I was 3 years old. For the past 16 years I have worked for the Plymouth Parks
and Recreation Department. My current title is Plymouth Creek Center Supervisor
Please number your choices according to preference:
Heritage Preservation Commission
Planning Commission
Parks and Recreation Commission
Public Safety Commission
Important Information About Your Application
Data Privacy Notice: Minnesota law requires that you be informed not legally required, but refusal to supply the information request-
of the purpose and intended use of the information you are provid- ed may affect the City Council's ability to accurately evaluateyour
ing on this application. Per Minnesota Statute 13.601, subd. 3a, your application.
name, address, length of residence, occupation, education, training,
civic affiliations, qualifications, experience, and veteran status are Should you be appointed to a City of Otsego public data and
available to anyone who requests the information. Commission, your residential address and either a phone number
or email address where you can be reached will also become public
This information will be used to identify you as an applicant, enable information (per Minnesota Statute 13.601, subd. 3b). The purpose
us to contact you when additional information is required, send you is to list contact information for Board/Commission members on a
notices, and assess your qualifications for appointment. This data is public roster.
Please select which of the following you will allow listed on a public roster (you must select either email or phone number).
mail ❑phone 1:1 both
Signaturep phY1 Digitally signed by Angie Dehn Date
Angie
Yt 1 1 g I G D G I III Date: 2021.01.04 15:07:59 1/4/21
-06'00'
Email Completed Applications to: bbenting@ci.otsego.mn.us
13400 90th Street NE, MN 55330 0 0
763-441-4414 1 www.ci.otsego.mn.us of
tkzo
MINNESOTA
Advisory��City Council
Application 1 / Release
Name Phone
Brad Smith 736-486-8325
Street Address City State Zip
15501 79th Street NE Otsego IMN 155330
Email address Number of years/months resident of Otsego
brad.m.smith@charter.net 19+
Please list any special interests or training you have that could benefit a particular Board or Commission (attach a separate sheet if necessary).
As stated, with the exception of the year 2006, my family and I have been residents of Otsego since the fall of 2000. 1 have an
extensive background in construction, construction related consulting including cost associations and a strong desire to see
Otsego developed in a managed and proficient manner. This includes a diverse base of housing opportunities, industrial,
commercial and light commercial, or retail entities; established in locations to be beneficial to the entire community with the
smallest amount of negative effect on property owners and valuations. Otsego can and should become a target market for all
group categories mentioned above. However, without competent leadership to oversee the process, the desire we need to
create will vanish and growth in ALL areas will plateau and/or diminish.
Please number your choices according to preference:
Heritage Preservation Commission
✓ Planning Commission
Parks and Recreation Commission
Public Safety Commission
Important Information About Your Application
Data Privacy Notice: Minnesota law requires that you be informed not legally required, but refusal to supplythe information request-
of the purpose and intended use of the information you are provid- ed may affectthe City Council's abilityto accurately evaluate your
ing on this application. Per Minnesota Statute 13.601, subd. 3a, your application.
name, address, length of residence, occupation, education, training,
civic affiliations, qualifications, experience, and veteran status are Should you be appointed to a City of Otsego public data and
available to anyone who requests the information. Commission, your residential address and either a phone number
or email address where you can be reached will also become public
This information will be used to identify you as an applicant, enable information (per Minnesota Statute 13.601, subd. 3b). The purpose
us to contact you when additional information is required, send you is to list contact information for Board/Commission members on a
notices, and assess your qualifications for appointment. This data is public roster.
Please select which of the following you will allow listed on a public roster (you must select either email or phone number).
kle mail ❑phone 1:1 both
SignatureDate 1 /5/20
/� �>
Email Completed Applications to: bbenting@ci.otsego.mn.us
13400 90th Street NE, MN 55330 1)
763-441-4414 1 www.ci.otsego.mn.us O,(_^T�` O
MINNESOTA
CouncilCity Advisory Commission
Application •
nd Release
Name Phone
Laurie Jones 651-334-1770
Street Address City State Zip
5217 Ramier Ave. N Otsego �MN 155374
Email address Number of years/months resident of Otsego
lauriet1125@gmail.com 1 month
Please list any special interests or training you have that could benefit a particular Board or Commission (attach a separate sheetif necessary).
I just moved to Otsego in November. I have 43 years of land development experience and am nearing retirement. I would love to serve on the Planning Commission here in Otsego. I believe my
experience would be of good value to the city's growth and development. Most importantly, I love what I do and I'm so excited to put my experience to use in my community.
My Background:
+ Civil Engineering Education -Michigan Technological University
+ 25 years with Ellerbe Becket: Lead (land development, entitlements and site construction) over 35 large projects (25AC-300AC) nationwide
+ 18+ years with Target Corporation -Real Estate: Lead land development of 130 new stores nationwide, four 1 M+sf Distribution Centers (California & Canada) and three 500Ksf Automated Food
Distribution Centers (California, Texas and Ohio)
+Extensive experience working with community development, planning and public works departments, economic development, city attorneys, council members across the nation on all my projects
+Extensive experience preparing for and presenting to Transportation Commissions, Planning Commissions, City Councils, Community & Neighborhood Groups, Design Review Boards, etc.
+Extensive experience negotiating Development Agreements with Cities
+Extensive experience with hostile communities (anti development) and been successful at building credibility for the developement
+Extensive experience with consultants such as traffic engineers, land use attorneys, civil engineers, architects, landscape architects, etc..
Please number your choices according to preference:
Heritage Preservation Commission
Planning Commission
Parks and Recreation Commission
Public Safety Commission
Important Information About Your Application
Data Privacy Notice: Minnesota law requires that you be informed not legally required, but refusal to supply the information request -
of the purpose and intended use of the information you are provid- ed may affectthe City Council's abilityto accurately evaluateyour
ingon this application. Per Minnesota Statute 13.601, subd. 3a, your application.
name, address, length of residence, occupation, education, training,
civic affiliations, qualifications, experience, and veteran status are Should you be appointed to a City of Otsego public data and
available to anyone who requests the information. Commission, your residential address and either a phone number
or email address where you can be reached will also become public
This information will be used to identify you as an applicant, enable information (per Minnesota Statute 13.601, subd. 3b). The purpose
us to contact you when additional information is required, send you is to list contact information for Board/Commission members on a
notices, and assess your qualifications for appointment. This data is public roster.
Please select which of the following you will allow listed on a public roster (you must select either email or phone number).
mail ❑phone both
Signature Date 12/23/20
Email Completed Applications to: bbenting@ci.otsego.mn.us