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�4'lts�i iS w�yur vi��w r,f fhc �-�71t: �o-E i!li� {'r�i�i�a�i���c,». ("..�t�i�i[�5���,Tasl: F�rt�c;' <br />Other Comments: (Include a�2y furtlael� :; ��:�:; ;; �c�: �•:; r you would like the Ciry Cou��.czl to consider or <br />that you feel is relevant to the a��oint��zen�t�>ou are seeking. You �ncty also attacla other nzc�te��iaCs you <br />would like the Council to co7�sider.} <br />Tennessen Warning - Some or all 'I,.- �ufoz7l�ation fl�at you are asked to provide is classified by State law as either private or <br />confidential, �'rivate data is z��#�ol-�natio�s that generally cannot be �v�n to the public but can be given to � i� st�bje.et of fl�e data. <br />Coaafiden�ia] data is information that generally cannot be given to either the public or �;,fi subject of the data. <br />The Ciry of Roseville is collecting the ix�faz��atio�l tp dete7.�za�ine qualifications to serve on a Ciiizeil Advisory Co��nussioil_ <br />You are not legally requi�ed to provide tJ�.is iu�o��at�oa1. However, if you do not supply t3�e information, you n}ay nat serve on <br />a Citizen Advisory Gon��ssion. <br />Other pel-sons or e�t�ties authorized by law to receive t�7i�s i�forrz�ation are City �ouzXCil naei�ibers; staff, residents of Rosevil�e <br />and interested otliers. <br />I understand i] i.i ; all zz�foz�.�afioil provided in tius application, except i�-�y �e1epl�oz�e i�u��bers, fax n;T��.�r and <br />e��.lail address, inaybe dishil�t�ted by the City to the public including, but not lunited to, being posted on ��ae <br />City of Roseville vvei�site, I agree to waive any and all claiu2� under tl�e Minnesota Goven��e�fi Data <br />Practices Act, or any otl�ez applicable state ;a:� federal law, t��a� irE any way related to t�ae dissemination to the <br />public of i�on��atio� contaizled:;: �l��i.; applicationt��at would be classified as private u�.ade� such laws. I <br />understand tlaat I za�ay contact t��e responsible authority for t��.e City of Roseville if I have any questions <br />regarding the public or private nature of the i�afo���atioa� provided. <br />I understand that the City will z1c�� publish my phone or fax ��umbez-s or eiaaail address without i��y aufl�o��zaizon <br />and do hereby allow tl�e City to publish (check all t�1at apply). <br />1�c��a�e telephone 1-��ua��er <br />�work telephone � �1�:i:1 �,�r <br />�hQi�ae en�azl address <br />�ti;����. � �.-� y, i� ��r:c�rti 4; � <br />�_ . <br />`_ ��� /�� . .. _ <br />k����at�:ro c� ��1 ���—� <br />.�p�p��arap :r:�u.5�a <br />- - -- �`��' � � �C�� <br />Date of A�plzC�af�o�a <br />