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Other Cotrameatts: (Include any further infor-rnation you would like the City Council to consider or that you feel is relevant to the appointment you are seeking. You may also attach other nucierials you urould like the Council to consider.) Tennessen Warming -Some or all the information [hat you are asked to provide is classified by State law as either private or confidential. Private data is information that generally cannot be given to the public but can be given to the subject of the data. Confidential data is information that generally cannot be given to either the public or the subject of the data. The City of Roseville is collecting the information to determine qualifications to serve on a Citizen Advisory Commission. You are not legally required to provide this information. However, if you do not supply the information, you may not serve on a Citizen Advisory Commission. Other persons or entities authorized by law to receive this information are City Council members, staff, residents of Roseville and interested others. I understand that all information provided in this application, except my telephone numbers, fax number and email address, may be distributed by the City to the public including, but not limited to, being posted on the City ofRoseville website. I ague to waive any and all claims under the Minnesota Government Data Practices Act, or arty other applicable state and federal law, that in any way related to the dissemination to the public of information contained in this application that would be classified as private under such laws. I understand that I may contact the responsible authority for the City of Roseville if I have any questions regarding the public or private nature of the information provided. I understand that the City wilt not publish my phone or fax numbers or email address without my authorization and do hereby allow the City to publish (check all that apply). -home te]ephone number -work telephone number -home Fax number -work fax number -home email~ess -work email address of -other telephone number 8' -31-~ 7 Date of Application Apprirntion 061114 Z•d EtrDEEE9i S9 Xtid 13Cb35H~ dH WdDE=Z LDDZ SO daS