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'I��at i� �•uur fiie�� u� �r �al� uf t� C�nuniss�t��Gt�mmi[t�e�C'�.sk �+��`c�� <br />� C�{� �� '�i� �� IN� r Sr:�; }-••� • , ;,:L{�t�,_.,� r �� i•��' � i�l �� df?f '����� — <br />�� i i��+� � � �fv��y�',Nf��� ''` ., =��LS�'�?�'y. —,h7�C{'-'� . <br />. =k+..�-- �±�� ._��'_-:��.,���r�+ � r_��'^� <br />—���'�=Yi'� _ . — _ � _ . � _—_� <br />Other Comments: (Include any further info�mation you would like the City Cauncil to conside� o� <br />tlzat ����� feel is Nelevant to the c�poitztnie��t you are seeking. You may also attach otheN mateNials you <br />would like the Council to conside�. ) <br />� <br />J.�I'��� i.i�i,{...�'.`.`,�..U��/I .1t7��'�?�,,�/FV, �}�� �{�,+-'L•, �,� 4�..� <br />+ { <br />�� �++ {�'-�L{'{� X+� �1 V L+Li� 1 L �: /� LJ L�� �`. <br />��� �. � , . <br />�T•�f� ���.!�rtF 5..��� �rp� <br />Tennessen Warning - Some or all the information that you are asked to provide is classified by State law as either private or <br />confidential. Private data is information that generally cannot be given to the public but can be given to the subject of the data. <br />^r;��de��;a; �a�ais iu.i��ria�iv;u that g�,aara�iy cannot �e given to either ;�� public or ti�e suk�ject oi i�e dau1, <br />The City of Roseville is collecting the i�fo��ation to determine qualifications to serve on a Cirizen Advisory Commission. <br />You are not legally required to provide this information. However, if you do not supply the information, you may not serve on <br />a Cirizen Advisory Commission. <br />Other persons or enrities authorized by law to receive this information are City Council members, staff, residents of Roseville <br />and interested others. <br />I understand that a71 info�ation provided in this application, except my telephone numbers, fax number and <br />eznail address, may be distributedby the City to the public including, but not limited to, being posted on the <br />City of Roseville vvebsite. I agree to waive any aald all claims under the Minnesota Government Data <br />Practices Act, or any other applicable state and federal law, that in any way related to the disserr.�z�atia� to the <br />public of information contained in this applicationthat would be classified as private under such laws. I <br />understand that I may contact the responsible authority for the City of Roseville if I have any questions <br />regarding the public or private nature of the information provided. <br />I understand that the City will not publish my phone or fax numbers or ezaaai� address without my authorization <br />and do hereby allow the City to publish (check all that apply). <br />home telephone number <br />w o r k telephone number <br />home ernail address <br />w o r k ezz�az� address <br />���' [��.,€`.�� � �r, <br />Signature of Applicant <br />Applicah'on 050523 <br />�-� 6-06 <br />Date of Application <br />