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[• � ,i-- ; .— t R � 15: x,50 YGE T & BA I LL 612 344 1689 P . 04 /05 {hat is your view of the role of this orr lnisslott/ OMmittee/Task Forcel See At-t a chd . Other Conint en ts , (Include an yfin-ther inforination Yo u %vo uld like Me 00i Co a oicil to consider or that youftel is relevant to the up1m nrPnenr you are seeking. You uric, also crilach other melle rlal.� you Ui10 t(ld like, the Council to eo n.�kler,.) See Attached. Tenn a ssen Warning - Some or al [ the i n f'onnat f on that you are askad to provide is classified by St ate laNv as either private or eonf desYtia]. Private data is itzf'ormation that generally cannot be riven to The public buL can be given to the subjcot of the data. Confidential data is inforination that generally cannot be given to either the public or the subject of the data. The City of Roseville iS e0E16 -ring the information io deterniMP, qualifications to serve on a Citizen Advisory commission. YOU arc not legally required to provide this information, However, if you do not supply the information, you may iiet serve on a Citizen Advisory Commission. Oih�.%r persons or entities aUthorized by !amf to receive this information are City Council inembU5, staff . residents of Roscviirr. and inier ested oEh e,rs. 1 understand that all i nf'onna t ion provided in this application, except in), telephone numbers, fax number and email address, may be distributed by the City to the public including} but not limited to. beincy posted on the Cite of Roseville website. I agree to m1aive amy and all claims tinder the Minnesota GovernLment Data P ract ices Act, or any other applicable state and federal law, tliat in any way related to the d isseminat ion to the Public of information contained in this application that would be e1 sxf`iedi as private tmde r such laws. I Understand that I may contact tht rc:s onsibit authority for the City of Roseville if have any questions renardijnrr the p7i b l is or private nature of the information provided. 1 un de rstwid that the City will not publish niy phone or fax numbers or email address lvi th Wt 2nd' authorization arid do hereby allow the Cif' to publish (chce* all that apply). hone telephone number work- telephone nurnber e rnai l address i understand that Iwo be invited to w3 iatery iew by thc City Council that may be audio or videotaped. XP_F� / lle� C, -- �> "3 S i gna tare of Appl iCan t Date of Application Cdr lxki ,'�: 0510>3