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hat is your ;l <br />3y of the rGle Of WS COMmi -5si0af omrr11tteef r k Force? <br />i4- <br />IV <br />4` ► <br />TM <br />Other Comma ts: (IngIIrde 0rtY t1hur infOrmadOII U uld like the City ozmcil to cmui r or <br />i � rt _ r )a. &el r.r r �I arrt to the appointment ant a are seeking. You may also attar" other materials U <br />It <br />-Iterjuld like the 1117cil to com r. <br />C666ml- A�� LWWL <br />.�. cene MY <br />l rrLmatd�Jon r <br />I 6 <br />f`usxQS Warnlng or ill inf'mat that u are akcd t prowxd i t~la_si by %& law alhrtriv€�1e or <br />z-on rid eiitin t. Private rrr�tion that genarally cannot be Siven to the public but can be given to Che 311bjeet of the data. <br />t unridcnlial data is i shat generally cannot be g iven to either the public or the subject of the data. <br />Htc Crily of Ro sc�'ilie , eoltcceing the inforrrtation to detennine qualifications to serve art a Citizcta Advisory Commission. <br />� c ju are no f icuarlY r fired to provide this information, However, if you do not supply the in ra miat�ion, Yore rr uy not serve on <br />it Citizen Advisory Co mission. <br />(Wier persons or en ti tic author! ad by law to receive this information are City Council members, sLa i`f', residents of Rosev 1 ir. <br />z m d interested others. <br />1 Linderstand that all nforma Pion provided in this application, except my telephone numbers, fax number and <br />email l address, may distributed by the City to the public includ-�iog, hut. not limited to, b Bing posted on the <br />C i ty a f Rosevii le site, I a to waive auy and all cl under the Minnesota Govemment Data <br />Practices c t, or an other applicable state and federal law, that any way related to the dissemination to the <br />[nihIic of informaaoz contained in this application that would he classified as private under such laws. 1 <br />Unders twid that 1 m contact the resNnsible authority for the City of Roseville. if I have any questions <br />regarding the public r pn'vate nature of the information provided. <br />I Understand that the City will net publish my phone or fax numbers or email address Without my author! fi on <br />'111d do hereby allover the City to publish (cheek all that apply). <br />_ —home telephone her <br />-- —work telephone umber <br />email address <br />I understand that I mfay <br />t}rdracc; 05A)3 <br />terview by the City Council tfiat may be audio or videotaped. <br />Signftyp€ ofApplicanc <br />!l —S— O'l <br />Date of Application <br />S <br />