2. Contact Information

   Fill in either your email or phone number to receive a response from us.

4. Name:*
6. Email Address:
7. Phone Number:
9. Please Share Your Comment, Question or Concern*
11. Unless restricted by law, all correspondence to and from Roseville City government offices, including information submitted through electronic forms such as this one, may be public data subject to the Minnesota Data Practices Act and/or may be disclosed to third parties.
    
Leave This Blank:


13. 1. Receive an email copy of this form.
14. Email address

    This field is not part of the form submission.

15. Submit

* indicates a required field