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1��h�1 �5 k��u �� ;�i�.�rx r�� ��� �� ei� I�� a��' �h iti �.i� rrt�t i i��i�xl7?�"��rr��yi i d ��x:T��k �[frr�°', '.• �,� � i.{ ',�r�'� ��+ a,+� �-+-+ � <br />Other Comments: (Include a7�y fu�the� i�zfo�°nzation you would lil�e the City Council to conside� o� <br />that you ; ���r' is relevant to the appointment,}�oa.r. are ��� �r:� ����F You l�?rxy ,;�sr� attc�clz other inate��ic�ls you <br />would like the Council to conside�. ) <br />S e e a��� � f�� - <br />Tennessen Warning - Some or ail the information t�tat you are asked to provide is classified by �tate law as eitherprivate or <br />confidential. Private data is information that generally cannot be given to the public but can he given to the subject of the data. <br />Confidential data is information that generally caiviat he given to either the public or the subject of the data. <br />'I'lie City of Roseville is collecting the i�ifonnat�az� to deie��tnitae 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 menlbers, staff, residents of Roseville <br />and interested others. <br />I understand that all informationprovided in this application, except my telephone ilu�nbers, fax number and <br />email address, may be distributedby the City to the public including, but not limited to, bein�; posted oi2 the <br />City of Roseville wEbs�te. I agree to waive any and all claims under the Minnesota Government Data <br />Practices Act, or any other applicable state and federallaw, that in any way related to the disse�l�natiozi to the <br />oublic of information contained in this ap�lication tlaat would be classified as pi�ivate under such laws. I <br />understandthat I may contact the respcssible authority � rr the City- of Roseville if I ha�se a�y ��uesti���� <br />regarding the public or private nature of the information provided. <br />1 understand that the City will not publish my phone or fax numbers or e�ai� address without my authorization <br />and do hereby allow the City to publish (check all that apply). <br />�home telephonenumber <br />� a work telephone number <br />✓ home e�aii address <br />n a work email address <br />�-. - - <br />� �, . � � <br />��L-_�_.�_�� k�L-���� �-��` G�� a�, 2 eo 7 <br />Signature of Applicant Date of Application <br />Applicatioi: 060621 <br />