CC_Minutes_2003_1013 - Laserfiche WebLink

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FROM ~ ED I h~A REALTY ROSEV I t..LE 8~9 6~6~8 ~~~3 0 8'7°28 a8 ~ 57 #l~8~ P . ®~/Q4 ~'~~~ a~tr Cutlatttenta: (Include any,further inform®tiort you would like the pity CCva~~cil #Q cansirier ar that yotc f 'eel is relevant ro the inttnent you are s~~rt~ ~QU mtay also attach other roaaterrals you would like the Counefl to cor~st'der~ Tenneraeo Warning - 3omc ar ®ll the information char you are asked to provide is c]assifiod by State law as eithet' private or cuii Idcniiat. rtivetic ciaia is ]nf6rrriaiinn fitat gceurel]y cRnnoi ae bivCti iv Uic puo9ic oiii can tic given to thr suojoci of the data. Canfidentinl data i6 information that generally ctnnot bo given t4 atthor the public ar the aubjacc of the data. The City of Roseville is collecting the information to determine quQlification~ to serve on a Citirdn Advisory Commiaaion_ You are not tagilly roquirod to provide this information. However, if you do not eupp]y the information. you mfly rtot sorvc on a Citizen Advisory Commission. Ocher persona or entities authorized by taw co rtceive this inforzr-ation ara City Council mmnbcrx. staff, raaidenta of Roseville. and intereatod others. I understand that all information provided in this application, except my teltphor~ numbers, fax number anal email address, Away be distributed by the City to the public i~cludiAg, but not limited to, being posted on the City of Rosevlllc wct~sitr. I a~rec to waive any and all claims under t~ Minn,~sata Covemment Data Practices Act, or any other applicable state and feral taw, tl~tat in any way related to the dissemiztation to the public of iAfamaatioa c+o~ntained in this application that would be classified as private under such laws. I understood tbttt I may contact the respo~ible authority for the City of Roseville if i have any questions regardixtg the public or private nature of the information pmvided. 1 understand that the City wall not publish my phony or fax numbers or email address without my authari~atioA. and do hereby allow the City to publish (check all that aPPIY)• ~. honk telephone uumbsc ~, email acidres9 ,~ work telephone n~ber I understand that I may be invited to an interview by the City Council that maybe audio or vidcotap~. ~~~ - Si~nattare of ,Ap~lie~nt Date of Application u ; mroa