2. Your Name:*
4. Your Address:*
6. City:
7. State:
8. Zip:
10. Preferred Telephone:*
12. Other Telephone:
14. Email Address:*
16. Block Party Location:*
18. Date of Block Party:*
20. Estimated Start Time:*
21. AM or PM*
    -- Select One --AMPM
23. Estimated End Time*
24. AM or PM*
    -- Select One --AMPM
26. Number of People Expected:*
28. Are you planning to block off any streets?*

    1. YES
    2. NO
30. Which streets are you planning to block off?
32. How much yellow caution tape is needed? (50 ft sections)
34. 
    Yellow caution tape can be picked up at the Police Department Monday, July 24 through Tuesday, August 1 from 8 AM - 4:00 PM. Please be aware we are unable to block certain streets. You will be contacted if your street cannot be blocked due to high traffic volume.
36. Special Visit Requests (e.g. Fire or Police Department):
38. Other Comments:
40. 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:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit Submit and Print

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