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W1��i �s ��a�- v��w o� tl�� �•��e �f tl�is C����issionlC������ii��l'� �s� �'��-�e? e� Cc Q C wr �-� -,L <br />�th�r Cog�t�e�fs:_ (Ii2clucle an�}> fur�the�� i��for°r��aiio�z you �n�ould lil�e tlae City� Coua�.cil to ca�zsrde�° ot° <br />� tlnnt , na� � t ln tlan nnnni��hr12Y4t Un7a r7YP.cPP]Z]T2�_ �at,��)q2�V Q�SO C�iILlC�1 Ot�2G1" 772LIIe!'iCllS 1>Otl <br />{�44� 7 C 7^P�PIJl7i9, . <br />..4..,...�1.�,.��..�,....� ............... _� _.... --rr_�.,_..-----✓--- --- , o- <br />�vould like tl�.e Cour�cil to co��sider°.) <br />S � e a f�a ��t �-' �- � <br />Tenz�essen Wai•ning - Some or aII the i��formation fhat yov are asked to provide is cIassified by 5tate law as eiil�er private oa� <br />confidential. P�•i�ate data is info�-mation that ge��e�-ally caiuiot be given to the public but can be given to t��e subject af the data. <br />Co��#ic3ential data is u�formation tl�at ge�lcralty cannot be given to eitl�er the public or tl�e subject of the data. <br />The City oi Roseville is collecting i#�e inforn�ation to detei�nuie quali�cations to serve oai a Citizen Ad�isoiy Conaxaaissioi�. <br />You are not legally required to provide this i�lforn�ation. However, if you do not sup�ly tl�e infaa�matioai, you may i�ot serve on <br />a Citizen Advisory Coirunzssion. <br />Qther perso��s or entiTzes aufhorized by law to receive this info�nlation �re City Council members, staff, a�esidents af Rose�iile <br />and inierested others. <br />I u�ders#aild that ali infoz�nation provided in this a��licatio��, except iny telepl�ai�e numl�ers, fax ��u�ni�er ai�d <br />email address, may be dist�ibuted by fihe City to the public ii�cluding, but nat ]i.��ited to, beu�g posted on the <br />City of Raseville websitc. I agree to waive any at�d alI claims tzi�der t��e Mi��lesota Gavei-nme��t Data <br />�'ractices Act, or any otiaer applicable state and federal law, that in atry way related to t�ae disse�lunatio�l ta f.he <br />pu�lic of n�fonllatioil contained i�a this appIication ti�at wo�ld be classified as privat� �u1de�' such laws. I <br />LiT1G�P£S13'_:�:�lat T ITl`d j' �CI1�?�� t;;� ;':S't"�^1�51�':� u','.�1.`ii7.f`y F�T t�zE ��.1�� ^v�i�GS�Vlii2 l�i lia'vC ai1 j� Cii.ie5iluilS <br />z-egardi��g tlze pu�lic or private nat�ue o£the iilfonnation pravided. <br />I ualdersiaa�d tl�at the City t�ill not �ublisl7 i2�y plaane or fax nu�Z��ers or email address without iny autlZOrizatioi� <br />and do hereby allaw tl�e City tn publish (cl7eck all il�at apply). <br />�ho�ne telephone nu�nber <br />� a wox�k telepl�one nun�ber <br />✓ ho�17e email address <br />n a warlc email adciress <br />Sig�lature of Applicatlt <br />,�P�ttG�rro,z a6n�a� <br />��� �" 7 ,y � DD �% <br />Date of A��licafi.a�� <br />