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�aai �s yo�a� �ie� mf �� ro�� �it�a�s ���z��ssia��afCa��sz�t��e/'T'�s� �`ar��;'� <br />��he�- �m�aa�er��fs: (Include any further in, fo��rrzatian you would like the City Cnuneil to cot�.srder� or <br />tlzat .yau feel is r�elevant to t.he aPpoir�t�azent you a��e seeking. You rnay alsa a�taelz othe�• �a�ater�ials yau <br />'Tennessen Warning - Soine or al� the irz�or�ataon i�hat yo� are asked to provide is c�assi�ed by State law as either pr�vate ox <br />con�cletliiat. �rivate data :s i�fozxz�atia� that �enerally can.not be aiven to t�e p�tblzc lai�t can l�e given ta tlze su6ject of t�e data. <br />Coi�fidential data is in�'orrr�ation t�at genera�ly cannot be �iven to either tl�e public or t11e sub�ect of the data. <br />�'he City of Rosevi3le is collectiin; the inforrz�atian ta dete�-rrzzne quali�zcations ta sezve on a Citazen Advisory Comrnission. <br />Xau are nat le�ally rec�uired to prpvide ihis inforr�ati�n. Howevez, if you do noi supply Ek�e ir��p��natior�, yc�u rrzay np�: serve on <br />a Citizen Ad�isory Commission. <br />Other persons or enfiities authoxized by !aw to receive ti�is infarrnation axe �i�y CounciI members, staff, residents af Roseviile <br />and interested others. <br />� ut�dexsta�d t�at a1X iz�fon�atzor� pzovi�ed a�3 tla�s applic�t�an, cxcept rny �:ele�ak�o�e aau�bers, �ax �iuznb�r. ar�d <br />��x�ail addzess, xs�ay be disi�zbuted iay the City to t��e �ublic includin�, bu� z�at �z�.zted to, beiz�.g �osted o� t�ae <br />City o�Rasevil�e we�szte. Z agr�:e fio waive a�-�y az�.d aII claims under tl�ze Mztaz�esata Gove�ent Data <br />Practices Act, or �y flfihez appiicable staie a��d fedeza� law, t�ai zn any way reiated to i�e dissemirzation to the <br />p�b�zc o� �r�.f€�z��atio�z can�aiza�d ir� this a�plicatio�z that would b� c�ass��ied as p�ivate uz�der suckz �aws. � <br />u�dexstand tliat 7��ay cbz�iacl ��.� r��pnzasibl� au#h�zity for i�.e City of Rosevili� if ��ave any qu�stions <br />re�ardi.�g the ��blic or �rivaie n�iure of �he information provided. <br />I�nderstazad ��at t17e C�ty will �zot �u�blish nr�y p�oa�e ar �a� zaurzmbe�s az emai� address wz��o�� r.n.y aurhorization <br />and da ��ereby a11ow t�e City tQ pu.blis�� (ck�eck a11 t�a�: aPP�Y)• <br />f hoz�e telep�one �urnbe� . " ` � � <br />� .... <br />_ ,:. ._... . _ <br />✓ work te�ep�one �umbez: . ._ . <br />--�— . _... ,-. __.:. __� <br />✓ emaii address .; ' _ <br />Signat�zre ofApplicaz�x <br />!{ppk'crzrinn 03101 i <br />�.�i�/�� <br />�7a1;e 0� A.�plzcatzOn <br />