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08/29/2007 16:35 FAR 651 633 9221 ROSEVILLE PROPER'PI E'S [~ooz What is you r view of the role of this Commission/Committee/TaskFarce? 'Tb NY2O 971E% Ct~c.lt~dC. L'~S4!?-E f"flfi~ Cain P~97'~ tt ~~l3~ ~1 ~Ciblt 8'tsP -~ ~1GW79a/OL~6 6y119fl PAS t P29f7<- ®ther Comments: (Include any further information you would like the City Council to consider or that you feel is relevant to the appoinpnent you are seeking. You naay also attach other materials you would like the Council to consider.) Tennessen Warning.- Some or all the information that 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 informaton to determine qualifications to serve on a Citizen Advisory Commission. You are not legally required to provide this informaton. 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 aze City Council members, staff, residents of Roseville and interested others. I understand that alt 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 of Roseville website. I agree to waive any and all claims under the Minnesota Government Data Practices Act, or any other applicable state and federal law, that nl any way related to the dissemination to the public of information contahied 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 ofthe information provided. I understand that the City will 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 telepho e nu ber ~ork telephone number -other telephone number -home fax numb r work fax number home email ad s '"work email address of Applicant fs'7-q .O"7 Date of Application Application 061!19