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IIi�titi� l�.�s 31r«r 3 i�';3 c��� [�Ifi C�U�� IMI�tIII.� f�trI11f11iSa1�91 �•������� sin�� ��a���r Lii�i [��i'r��'� <br />.. ..--��---•------ • — <br />� ��' t �' � � f{ r•�f, � <br />�k- �'-�-�c.. {�A•��i•L ��t � .ra � =����.'�'�i•�''i � �� � �_s_+ Ls _ ��_� Zi.� � �: � • ��1r��� �kJ�' �� <br />j ,� * J— ��_��'. ��V'�-�"��,+–� �. '�F•f�..ti LCs� � <br />�-� /�11 �4� �'�.•���� .��--�---- . - <br />t� <br />: � �� � �.� �.r Ez � <br />L �ey n � � �� _ tT • al 1 . <br />,� �--:-- �� <br />,� t f ti. �. l r a+. ��Yxt f: �?� n r�r. ,.� �; � <br />} tJ�r � � <br />s_C. . JL.2 ��_. t� ��i`l'LC. <br />'� ,� � a �.� <br />Other Comments: (b2clude :�a�.� furtlier i�zfo�»�atioiz you �i t�r�ii� like tlie City Council to consider o r <br />� � <br />iii r!! '.�r1[I �r3.'�'1 1 5� ��r'I L'�� f!1!: ii ���,- :I���� 'fJf� l t� �: {'r� i 5�� 'I+ �� Ir�'.' f� rSfk i�tii rl'�I flili i'i' �i lr� � i:1'i: i I.L �': li i�Vi��ir' I��'�� .' �� �r' <br />�:��urac°ii do cr���s�ir���-.J '�/��..r .' . � � '. .�. .r �' ��l,rvf.�, ��,���a-l� �r�4�� �'1��=���. <br />� �[ r � <br />r�5.�f'"jl � • • 4 �•�+�••�^Y' s•�t���{� �`^�,. ,����_*,�f <br />t <br />— .. . -- i � �_ . _�: ��� � �� i.�� '��t�.�� ��..��.r..�,. �� ��'� <br />:,�- � � ._� ''-�. �� ���� ��__�_,� ���� �;_ <br />- . . . .� --- I <br />,;�_ � ... f� .. .:r���.���� .�.� <br />_ � _�.c��.�� i�' ��.�_�� _ r��a ��, - --- - ._-� Y��� _ <br />,— �. � <br />,r <br />Tennessen Warning - Soine or all the inforinarion that you are asked to provide is classified by State law as eitherprivate or <br />confidenrial. Private data is information that generally cannot be given to the public but can be given to the subject of the data. <br />Confidenrial data is infoz�nation that generally cannot be given to either the public or the subject of the data. <br />The City of Roseville is collecting the infoi�nation to deternulie qualifications to serve on a Citizen Advisory Coilunission. <br />You are not legally required to provide this infornlation. However, if you do not supply the information, you may not serve on <br />a Cirizen Advisory Comn7ission. <br />Other persons or entiries authorized by law to receive tlus iufom�atioil are City Council members, staff, residents of Roseville <br />and interested others. <br />I tiur�derstand that all information provided �a tlus application, except my telephone ntunbers, fax nLU�7ber and <br />e�nail address, m;�'Y be distributed by tla.e City to the public including, but i�ot �zlnited to, being posted on the <br />City of Roseville website. I agree to waive any and all claims tuider the Mii�lesota Govel7unent Data <br />Practices Act, or ally other applicable state a�ld federal law, that u1 any way related to the disseminationto the <br />�ublicofin�t;�n�..��t•���co��ta;��edii�t�:�s;��-�i-��i�:_�i��n �ii,�luwouldbeclassifiedas�rivateii�itivi suc��.laws. i <br />understand that I may contact t��e responsible authority for Ll i� City of Roseville if I have any questions <br />regarding the public or pl�vate nature of t11e infoi�liation provided. <br />I understand that t��e City will not �i; d�i=kli my phone or fax ��u��bers or enaai� address without my a�.rt��oz�zation <br />a�1d do hereby allow the City to publish (check all LhxL apply). <br />�home telephonenuznber <br />work telephone ��u�aaber <br />�L34L17� C:71�1lI ;uicirt�w <br />�W�lh 4'717c11 �rl{� j7�4� � . <br />.� <br />I <br />�� ��� .�_ �x�'�-�-�'� <br />� <br />... . � �Mf�`r Gl �.�F7�7LI L':JClt <br />��.�,;�;��m�u��rrmK��� +� � <br />�� <br />� 'r.�: � ��r�l�� �� <br />fl;ai c ��f �JrPlicr��i��5 <br />