Weinblatt, Deacon (Deke)713400 90th Street NE, MN 55330
763-441-4414 | www.ci.otsego.mn.us
City Council Advisory Commission
Application and Release
Name Phone
Street Address City State Zip
Email address Number of years/months resident of KƚƐĞŐŽ
Please list any special interests or training you have that could benefit a particular Board or Commission (attach a separate sheet if necessary).
Please select the Commission you are applying for,
if more than one, 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 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).
email phone both
Signature Date
ŵĂŝůŽŵƉůĞƚĞdƉƉůŝĐĂƚŝŽŶƐƚŽ͗kkallandΛĐŝ͘ŽƚƐĞŐŽ͘ŵŶ͘ƵƐ
7-7:00