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��'h a� �� k�i�q r 3i���+' [�f 1 ht rtrCt� ��f � � is C'�iii rais�icfn: C_'ri �nmi'L�r{•r�l`�,s k I�'r� et �' <br />---.. . � <br />s �. <br />,� ' �.r _� .�t. 1 � <br />� � , j�?, _ , _c� - . . i � <br />Other Comments: (Include mzy further : r;+r:� ��r����•��; r you would like the City Cou��.cir to consider or <br />that you feel is relevant to the appointment you ar�e seeking. You r�-�,,r also attach otlzer materials you <br />ia�ould like the Council to consider) <br />� `�� � .�.�.c�t-+ � . � f ! .� " -- � -� � -- <br />- -� <br />Tennessen Warning -�-"•1]'� or ail the infon3�ationtl�at you are asked to provide is classified by State law as either private or <br />coa�dez�tial. Private data is infoznlarion tt�at generally cai�iot he given to the public but can be givezl to t1�e subject of the data. <br />Confidential data is information that generally cannot be given to e€tI�er tlte public or ti�e subject of tlie data. <br />The Ciry of Roseville is collecting the information to detennine qualifications to serve on a Citizen Advisory Conulussion. <br />You are not legally required to provide this information. However, if you do not supply the infonnatian, you n�y not serve on <br />a Citizen Advisory Con�nission_ <br />Other persons or entities authorized by law to receive'��; o- ii�foimatio� are Ciry Council members, staff, residents of Roseville <br />a��d interested others. <br />I understand tl�at all infonnation provided in tlus application, except my telephone 13�.unbers, fax i��zL�er and <br />email address, inay be distributed by the City to the public including, but izot limited to, being posted on the <br />City of Roseville website. I agree to waive any ai1� all claims under the Minnesota Gaver�u�e�-�t Data <br />Practices Act, or any other applicable state and federal law, that u� any way related to '1 ��= disseini�latioil to t11� <br />public of infonnation contained i� I] ii� application that would be classified as private u�2der such laws. I <br />tulderstai�d tlzat T inay contact the responsible authority for'.] i v City of Roseville if I have any questions <br />regarding the public or privafe nature of the infonnation provided. <br />I understand �l�at the City will not publish rr�- phone or fax numbers or en7ail address without my autl�oi�zatiail <br />a�id do hereby allow the City to publish (check all tllat apply). <br />_1 �c �. r��_ telephone n�.u�ber <br />_ work telephone number <br />��oz��e e�1�ai1 address <br />work�e,�zail address <br />- � �-� � <br />� ���� ��� •,�-�. -� <br />�i��tw�e �#� A�r��c�a�t <br />��r�,.:,.,M �: sa��� <br />�` - � �� <br />I�al r � ' <br />. vf .� nl):; r.alin-ti <br />