2007_0312.special_packet - Laserfiche WebLink

Home

�4��f t� �� _r�i�-,�' �� I}�� r��lc o� ft�i� �.�r�n u� i5sitr��.ottYU�i[#��T�k For��?- ��+� .� } { �+ _ -��W�ri�/� ��r�sl f.i J r�.J� i �f7 �+� -i!+��i�/.�'8.X1•� ��; �� I � �.,#ff �l�lrl�� -�� - -��Q'/�"..��, Other Comments: (Include aYry fu�the� infoYnaation you would like the City Council to conside� o� that you feel is �elevant to the appointment you a�e seeking. You may also attach othe� mate�ials you would like the Council to conside�.) : —� . J � ��-+� r�. F � � rl �� ��1,��;� :r�.•�� ..��., �w:, ,_., : r'.. ... r� r �a��w� ��lJ�ye�.._� �, _ ��c�4 _ � � ��'.�+� _ � �� ._ _ _ � —'�. � $ � r� -'�.,�r � f Lf f��.�,�.��. fl�F;�� /'.!r��F-11��-� � � L• • .�� "�"et�nesse�€ Warning - Some or all the information _Fr�� 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 subj ect of the data. Confidential data is information that generally cannot be given to either the public or the subject of the data. 'I`he 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, residenfis.of Ttoseville and interested others. I understand that all information provided in fihis application, except my telephone numbers, fax number and ez�aail address, may be distributedby the City to the public including, but not limited to, being posted on the City of Roseville webs�te. I agree to waive any and all claims under the Minnesota Government Data Practices Act, or any 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 tke City will not publish my phone or fax numbers or e�ai� address without my authorization and do hereby allow the City to publish (check all that apply). � har�,,� t�CepEroa �e �,urr,be,r � s r ��° � � � � ! �e�c #e[ep��r�e ��ri�er � � � � � � ; � � �o� �r� . r �t�a�] a.�r3ress � ��. �� :?? r� � ��_ �.. ��-� . • -- • ,� � �� —� ��r`,�� " � - �� '�--- — --- -- ....__ 1�� -�r Signature of Applicant L�ate of Application App&cation 031017