Please complete this form for Roseville Fire Department use. This information will be kept on file for use in an emergency.
When finished click submit at the bottom of the page. You may also choose to have an electronic copy emailed to you for your records.
Some or all information you are asked to provide is classified by State law as either private, public, or confidential. The data will constitute a public record if and when the registration is granted. Our purpose and intended use of this information is to annually update our records and records of other governmental agencies required by law. If you refuse to supply the information, the registration may not be issued.
2701 Lexington Avenue N ▪ Roseville, MN 55113 ▪ Phone: 651.792.7340 ▪ Fax: 651.792.7300
This field is not part of the form submission.
* indicates a required field