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<br />JAN-05-2006 THU 11:57 AM <br /> <br />FAX NO, <br /> <br />P, 02 <br /> <br />~jj~:~I~J.~~ y'.~~~~.~.y(~~._~.t!.hc ..ole of this Com.~_~~~.s)~~:,~i.i~!!g~(l since YOllI' i1~~~J~.~:~~'if:-,~:'~~~==-~==~~~-=~~ <br /> <br />. I \. I I .. .. _\" ... ....... t....-, ...___ __ .____.~""!____.....\._ ... ~ \./ AI I j t....-. \-.--- <br /> <br />. '(:)lj~~~:'(:()';~t;~~iits:-(7/~Cl~iae-(iflyji;rii;;;;:"i~~-;'~;~ati()fl you 'WOlliJTik~"ij~(~ '(jiy-(:V~;~ci/ 10 ('on.s1d-;;;~'o" <br />{har youjed is rtlevant to re- appoinfment. You maya/so attach olher malt!riats you would Iik(! the <br />,_. ((}L~t.!~:!.L!!!... 0.!.~.~{t!..~:!.) "" _. ._____ --_.___,.._.. "" N - "..,------- .......... ..... '''' . <br /> <br />f \ /.,. f'" "N''''- ..._..._......._ __._____ _._._...... ___... ....__.J/I. ,1I.1"I,NIl' 11" 'V."j' ..-......---- <br /> <br />Tc;illCSS-(~l"W;li~I'~l~~- :S~)I'; i c ~)r' ~ i t' tf;~ "f;~f~i:;;-~ltion th<1t you um askcd to' pt:ovicre Ys"cl~.~~ifi cd by State law as ci lh~~-prf ~;;itc' (;; <br />(~onndcn!jaL PriY~Il(; data is infonnalion the1t gcncru1\y curm()l hI.:; giVl.:;n to the public but can be giwll 10 the: 1)ubjett of lh~ data. <br />Con lit kilt illl datIl is ittfommlion that generally canl10t be given to either the public Q)' the :,.il.lhjrct of the dnti.1_ <br /> <br />Tlw Cily of ROl)cviHe is colk:ct.ing lht) information to determine qunliflcations to ~ervc ()O a Citizen Advisory Commission, <br />Ynu 1]1'1; not legally rLlquirud Lv pmvidc this information. However, iryou du [lOt supply the information, you mny lH)l.servc Oil <br />n. ell i:t,~~n ^dyj"!~lry C\Hnn'J. issi(H1. <br /> <br />OllIe.. pct'~()n':) or cntitic::i Cluthori/.l:d by law to receive thj~ information arc City Council mcmbers, staff, rcshknls of R()~)l.:vjllc <br />nnd intr;n.'skd olht!f$. <br /> <br />I understand 1h~lt aU information provi<.kd in this application, except Iny telephone numbers, ihx number and <br />crnnil ~ddr(~~~; may be distributed by thl; City to the public including, but not limited to, being posted on the <br />CiLy of Rosovi1l0 wcbsitc. J ngrcc lO w~1ivc any and all c1airns under the Minnesota OOVcmIncnt Data <br />PnH..:liccs Act, or any other applicable state and Hxlcrallaw, that in any way related to the diSS~l1lhmtion to the <br />p\Jhtic of information contained in thi~ applicaliol1lhat would be classilicd {lS priV~ltc under sLlch laws. I <br />\lI'llk...~tand that I J11ay contact the responsible aU1.hotlLy for the City ofRoscvillc in have any questions <br />regarding th~ public or priv~lte nnturc of the infi)rrnation provided. <br /> <br />I llllder...:L:.md that the City will not publish my phone or fax numbers or cmail address without my nllthori7.\nlion <br />and do herehy allow the Cily to puhlish (check all that apply). <br /> <br />........J1()llle telephone l'ill1'nbcr <br />.._.., ..work telephone nUlnbcr <br />homo cmni I' i' rc:-;s <br />work e 1.. I <br /> <br /> <br />-.-... ./~{~-------- <br />i;l-/;t~PPlicalion <br />