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iVhat fis y®eap• veeav ®f the a~a9e ®f thas C®nraa,fissaon/C®ntcnatt~/Task ~QrCS'? <br />'llfC COK-fP ~Lr4k.~ t'S .4 '/~iC/aI1 ~fF~/~ ~-f~/l ~~lt FJCAA/A/lft:~ !>v Tt~t <br />®ther C®nznnents: (Include any further information you would like the City Council to cwrsider or <br />that you feel is relevant to the a~poi~atment you me seeking. You may also attach other materials you <br />would like the Council to consider.) <br />Tennessen Warning -Some or all the information that you are asked to provide is classified by State law as either private or <br />confidential. Private data is information that generally cannot be given to the public but can be given to the subject of the data. <br />Confidential data is information that generally cannot be given to either the public or the subject of the data. <br />The City of Roseville is collecting the informalion to determine qualifications to serve on a Citizen Advisory Commission. <br />You are not legally required to provide this information. However, if you do not supply the information, you may not serve on <br />a Citizen Advisory Commission. <br />Other persons or entities authorized by lxw to receive this information are City Council members, staff, residents of Roseville <br />and interested others <br />I tnderstand that all information provided in this application, except my telephone numbers, fax number and <br />email address, may be distributed by the City to the public includuig, but not limited to, being posted on the <br />City of Roseville website. I agree to waive any and all claims under the Minnesota Government Data <br />Practices Act, or any other applicable state and federal law, that in any way related to the dissemination to the <br />public of information contained in this application that would be classified as private under such laws. I <br />understand that I may contact the responsible authority for the City of Roseville if I have any questions <br />regarding the public or private nahue ofthe information provided. <br />I understand that the City will not publish my phone or fax numbers or email address without my authorization <br />and do hereby allow the City to publish (check all that apply). <br />home telephone number -work telephone number -other telephone number <br />-home fax number work fax number <br />-home email addre~~ ~- ~w9rk email address <br />Date of Application <br />Application <br />