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��t i� �rr��r w itw �+f t� � r�l� uf �L.i� �aa� mtssio��'o,�r�t�rc�ll'�ak F�rc�� r _' . . � � � . '�a ��r .' � `�-{4L'� Li�x'+�* L�t�'�+`= "� _ ��1�, —, . ' y+ �:t� �i..�:'_�•� ��L{cJ. _ r��l'j�] �+� L-'�'� �+.r � '7"r.� �J��'h+._{_.�_�_-',1�._� _.� � .'��''�� - — �� }N � �• '^^.�.c�� 4.i+�'�r4ati �--F i�i �:� ��'4c�C �• ri�'�.4c�d+� � �� Other Comments: (Include any fu�the� info�mation you would like the City Council to conside� nY that you feel is relevrn�t to the appazntn�ent you are seeking. You may also attach other materials you would Izke the Council to conside�.) 7 �'��.,J� t�}•,"��{,l •A�� ✓y�J,� �LL7�7 �'4 �'t�'.� `r�"` � 5G?�� {�? �� i:�.-ti�`"R.�. .. '�f�?,�.� • .' _ ' , " � ..+4�� / = t+r 7`"�� z� Y-�� .�'� �:� +�.y r.�' . . -- • • • --- . _ . _ . ... . ..• y Tennessen Warning - Some or all the information that you are asked to provide is classified by State law as either private or confidential. Private data is information that generally cannot be given lo the public but can be given to the subject of the data. uon��dert;a; ua� �s info�iva4�o� "w�� generally cannot be given io either �� ;blic or -�it• subject of the data. The City of Roseville is collecting the ir�for�atio� to determine qualifications to serve on a Cirizen 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 Cirizen Advisory Commission. Other persons or entiries authorized by law to receive this information are City Council members, staff, residez�ts of Roseville and interested others. I understandthat all information provided in this application, except my telephone numbers, fax number and ex�ai.l, address, may be distributedby the City to the public including, but not limitedto, being posted on the City of Roseville websi�e. 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 the City will not publish my phone or fax numbers or eix�.atl address without my authorization and do hereby allow the City to publish (check all that apply). home telephone nus�bez w o r k telephone number home ez�zail address w o r k ert�ail address , �. � �� -� 6- 0 6 Signature of Applica.rit Date of Application .�r,rr+�rASCs:;