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�'�a� i.s k�n��r ��+� af Yl�e r��r �rf t�i�s �'�inr�i�i�o1�'arniai��te��]'a�sk {�-�rce:' �� •r� +x� �� . �.�. ��ir+4��-�, ...�� -�x�r' � ��+� �+.. �' ��r� �� ,_. �•�� #L � ��I'��1' �� f��#� �.fLF��•�� ! �-.^�.� - _ � �'�� — r.�-c �� � �:°�t� � r C �� '..f.� �..r � c...a.. #� � � � F f f � r � �fr �� ' ��'�t,e �' r� �� sr-r o-r'f� �� �.r �r. �_ _ o�'.�.•� � � � _� �.�?`� ��c ��'� � � �� ' �� � � _ � �' �� ir � �:r� � r`7�� sr � � � --�� .�.� �, �� q� �� ] L'i �. rl�l��a1�'�� fr� r.��' � �Y}. �fi Fi ii C'F � �i�fJ+'?IJ22i2V� �'L� �� '�^'��i�� fi� �fi� �? �.�J�� ,{12irJF'I� �r 4:':�� 5'1:�2?.�' f+J' �� " � � � �� � r� ii i I•fjJ4� ii'•C'i i:: �'�•i :••, }'r� rf !fr !�{� iir��(�; Fr��Y� . r. � � `�.��CiPI�. ��?H� k �'1.Sd} f:�f�r:1i ��2��' �72�i i r'.�'ff��.S '�?�!� � ' . �� '��.�+?� �r�� t�e �'��ru��i� t;} L.r��ic;c�r � _ � # �r�� +,.� �! �# � � � r �[ � r rr ��r�Y �t-r �� f� �_ � . � #,�'.��r��°�r�''`�- �r. ��*� �'�-- r� -� ��..�� r�r_' �� - .. � � �+��_ � � f��.r.��, �co��c._ _�" �.��C � �'� or� � r�e.F =... � �J � � � �� / �� +�+� ' J� r�+./ � �� r`� r4� �,zf F l� � � �'v�__- �tr r� � � �� +�� r r+"�' �7* � � � r � �__ �r��,� S�r � r� � �,� �" �� _._ �� rr �'.t � _ _ ��r r �r S-� _ � r � �r� �---�''�. � - r � r+r � � r*...` ��. w.� .--� � .. � � �'�! �h �� f�S C++�*� �'+* r �' � f�� "� �� '�.� �� rd �" r�s+ �? � '7� �#'�� H iK ��f Tt• IGntsx��Y �k�N I'll I I' �,!. -.. .. .••r �I �� i :.. �- �.•.:I �n� I �:i I: ,�i i�� kk �:�1 Iti �yi nvi��: i��..�!.i!� - L'tl 1y:= �Iti L•� w�5 •: i ILt i°. i t'•� �w Lt y t:i,i__:.ir-•! r� I. :�i _•• �[� �`.�M1.i i�:i._� �� i;,i;7� �I i! ril e__i� I,i I' r• ;.i i_i_i�E �'�� I�'�: �: �:y "E it � �t17� ir hi i, �,�-i 1��; � r••�,i I:} I Fir �:i �h: r�•' :�" :! it• tl�l�. �� ' #�}� Confidential data is i�ifoa-inatioi� that generally cannot be gi�en to either the public or t�ie subject of the data. The Ciry of Roseville is collecting the inforn�ation to detemune qualiiications to serve or� a Citizen Advisory Cornmission. You are not legally required lo provide this information. However, if you do not supply the information, you may not serve on a Citizen Advisory Co�znussinn. Other persons or ei�ri�ies aud�orizedby law to receive tlus infonnation are Ciry Council members, staff, residents of Roseville and interested others. I understand t11at aIi uzf'orrnatioi� provided in thi� application, except i77y telephone ��s�znbers, fax r�t��ber and email address, may be distributed by the City to the public including, but not limited to, being posted on the City ofRoseville website. I agree to waive any and all c�aims under the Minnesota Gove��a�nez�t Data Practices Act, or any other applicable state a��d federal law, that ih any way related to the dissemination to the public of infot��latiorl contained i�� this application that would be classified as private under suc�� laws. I understand that I may contact the responsible authority for the City of Roseville if I have any questions regarding the public or pY�vate nature of the il�fo�7�atioi� provided. I iulderstand that the City will not publish my phone or fax numbers or e�riail address without i17y authorization and do hereby allow t11e City to publish (check all that apply). home telephonenumber �❑= k telephone number l�oine e�a�ai1 address ,fwcrrk ei�ail address ___� � � �� _ /' �� , , � Signaiure of :��::�- — ��,,.� �a�ra �� Date ofApplication