Kiffmeyer, Kelly1113400 90h Street NE, MN S5330
763-441-4414 | www.cl.otsego.mn.us
City Council Advisory Commission
Application and Release
Name
Street Address
Email address
Kaly KttmeyecTncpqnmail com Please list any special interests or training you have bat c
passion
nistorical
haue
Communie aten
itornatti on
Please select the Commission you are applying for,
if more than one, number your choices according to
preference:
NE
Xmal
to
Signature
Important Information About Your Application
Data Privacy Notice: Minnesota law requires that you be informed
of the purpose and intended use of the information you are provid
ing on this application. Per Minnesota Statute 13.601,subd. 3a, your
name, address, length of residence, occupation, education, training,
c0vic affiliations, qualifications, experience, and veteran status are
available to anyone who requests the information.
phone
This information will be used to identify you as an applicant, enable
us to contact you when additional information is required, send you
notices, and assess your qualifications for appointment. This data is
both
Speific
Phone
City,
Number of ygrsjme
9sa-994 -899l
to
Ene li su
t could benefit a particular Board or Commissio (attach a separate sheet ifnecessary. tor nis tory
Heritage Preservation Commission
Planning Commission
Parks and Recreation Commission
Public Safety Commission
Otsego
State
MINMESOA
|Date
resident of Otsego
Please select which of the following you will allow listed on a public roster (you must select either email or phone number).
Email Completed Applications to: kkalland@ci.otsego.mn.us
z msatt
not legally required, but refusal to supply the information request
ed may affect the City Council's ability to accurately evaluate your
application.
Seeech
Should you be appointed to a City of Otsego public data and
Commission, your residential address and either a phone number
or email address where you can be reached will also become public
information (per Minnesota Statute 13.601, subd. 3b). The purpose
is to list contact information for Board/Commission members on a
public roster.
11-8:00