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ghat as your vieev of the role of this Coissioaa/Conamittee/Task Force? <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 thesubject 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 information 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 ]aw to receive this information are City Council members, staff, residents of Roseville <br />and interested others. <br />I understand that all information provided in this application, except my telephone numbers, fax number and <br />email address, maybe distributed by the City to the public including, 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 />regazding the public or private nature of the information provided <br />I understand that the Ciry 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 address -work email address <br />~r~,K <.u_ sa ~x~~1o~ 9 • ~ • o ~ <br />Signature of Applicant Date of Application <br />Applicaliam 067129 <br />?,¢, ,, a s4 .ch `~`i rw ~tearc,u ~`r.ar rce.e ~~-,ce..,~ -~ a~..~ -~-~_ ~--~'~ <br />Other Comments: (Include arryfurther information you would like the City Council to consider or <br />that you feel is relevant to the appointment you are seeking. You nary also attach other n7aterials you <br />