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� <br />! <br />� <br />What is your view of the role of this Co�missian/Co�nmiffeelTask Force? <br />Other Comments: (Include any further infonnation you would like the City Council to consider or <br />t1�at you feel is relevant to the ctppoint��ielxtyou are seeking. You �nay also attach otl�er �a�aierials you <br />would fike the Council to consider.) <br />— � <br />'J'e�messen W arning - Some or all the inforn�atipn that you are asked to provide is classified by State law as either private or <br />confidential. Private data is infaz-n�ation that generally cannot be given to the public but can be given to the subject of the data. <br />Confidential data is information that generally cannot be given to either the public or the subject of tl3e data. <br />Tllt; City of Roseville is collecting the infonnation to detetxi�ine qualifications to serve on a Citizen Advisory Co�nllssion_ <br />You are not legaliy required to provide this information. However, if you do not supply �he infonnation, you may not se�ve on <br />a Citizen Advisory Commission. <br />Other persons or entities authorized by law to receive this information are City Council members, staff, residents of Roseville <br />; :° interested others. <br />I understand that all information provided 'm tlz�s application, except my telephone numbers, fax nu�-�ber and <br />er�i.ail address, may be dis�ributed by the City to the public including, but not lur�ited to, beitlg posted on the <br />City of Roseville website. I agree to waive any and all claims under the Minnesota Go�ern.tnent Data <br />Practices Act, or any otl3er applicable state and federal law, that in any way related to the d�ssei�inatio�l to the <br />public of infonnation contained in this application that would be classified as private under such laws. I <br />understand that I may contact the responsible authority for t��e City of Roseville if I have any questions <br />regarding the public or private nature of tlie infomiationprovided. <br />I understmd that the City will not publishmy phone or fax nnmbers or einail address without my authorization <br />and do hereby allow t�e City to publish (check all that apply). <br />,. <br />�_ i �c•� ���� telephone number <br />�f woxk telephone number <br />�hoi��e email address <br />,�vork e�nail address <br />} � ` �� <br />� � <br />-- ..�= .� �~ _ <br />�. ��**r�t�-r�R�i'.A. . 4 <br />.�.�RSrnrai rr�S�.� . � <br />� �� - � <br />_.. �.. . ._ <br />� Date of Application <br />