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�aa� �s ��u� �v�e�vv o� t�� ra�e mf t�is �G€���.issio�z/C`o��zi�ee/'�`a�sk �orc�? <br />�th��- C��t��:�€ts: (.Tnelude any fur�ther° infol�l��ation you �vould 1i1� �Iie �ity Council to canside�° or° <br />tl7a� .yau feel is i elevarat` to tlae appoir�traaer�t yau at�e ,seelczng. You 3�2ay also a1�ac7� otlie�� Tncztel�ials you <br />'�'enn�ssen Wa�-ning - Same ar all t�e in#ormatiQn that you are asked io prdvide €s classi�ied �y State !aw as eithex privaie pr <br />caza�ide�iiial. �ri�at� data �s ix�forrnaizon t�at �enera�ly car.�o? b� given to the �1�b1�c h�rt c�n I�e �ivet� �o the subject of the data. <br />Canfideni�ai data is infarm.aiion ti�at gen.era2�y can.not t�e �zven to eitl3er ttze pub�ic ar thc s�zbject of the data. <br />`�'he Gity of Roseville is calleciir�b the iz��ormatian ta deten�ai.��e quali�catio�a to serve nn a Citizen Advisory Carnmission. <br />You are not te�ally requiz�d to pro�ide this information. However, if you do not supply the i��'ormati€�n, you may rzot serve on <br />a Citizen Advisory Commissiors. <br />C)ther persons or entities authorized by la�� to recei�e this iza�'arr�atipn are City GounciI me�bers, stafi�', resid�,nts o�'i�osevilZe <br />and i�terested otlaers. <br />I understar�d lhat al� itxfon�aatiozz �rovzded u� tl�is applicatian, e�cept iny te�epha�e nuix�bez-s, �a� nutnber a�d <br />ezxaazl address, s�3ay be d'zsi:z�buted l�y t�e City to i�ze �ublic inc�udin�, but �qt �imited i:o, beir�g posted o�. t�e <br />Ci,ty of �osevzlle website. � ag�ee to �vaive any and a�I claiz�s t�nder �ze Minn�sofa Gov�rz�.�ent Data <br />�'xactices Act, or az�y o�ez applicab�e state and %deral 1aw, that i� a3�y way related to t�e dissezninatioY �o �:he <br />�uia�i.c n�i��orz�za�zor� eontair�ed i�� thzs app�zcatzozz t�at �a�ld be c�assz�ed as pxxvate under such Iaws. � <br />uzadezstand tlaat T znay contact the zespo�szb�e authaziiy for the City of Roseville if � have any questzo��s <br />regardi��g t�ae public or �a�vate na�.re of tlae i�orzr�ation provzded. <br />I u�d�rstand �aat tl�e C�ty wi1X z�ot pub��sh a�y �hone or �ax ��uzxab�rs o� emai� addr�ss wi�l�o�t rny autl�.orzzation <br />az�d do �Z�ze�y aIIQw t�Ze Cifiy fo publish (c�eck a�I that ap�ly)- <br />� �flrz�e teIep�one z�urnber K <br />✓ wark te�e�hone nu�l�er. <br />,i er.�ail addzess ._ _w__ <br />° Sig��ature o� <br />Appliccrtion 03if117 <br />1 ������ �� <br />�}ate o� A��lzcation <br />