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�� �l','It Iw 3i717�' k'if.5�' r}�� 1�ji I:���' ��� ���1} �.•r'117Ji7i5�IfiJ�•� III[illl,��k'�'' 1��''rti E'i`I �'i:;} -- <br />Other Comments: (Include a��y further :�; r��; :�, ���:'r� �: you would like the City Council to consider or <br />that you feed is redevant to r�: •- ap�oir2t�azei�t ��oza are seeking You »c�y adso at�aclz other r�zc�te�-ial� you <br />��ould I�ke the Council to co�zsider-.� <br />Te��essen W arning � Some or all the in.forn�atio�2 tliat you are asked to provide is classified by State law as eiti�e�- private or <br />co�fiden�ia�. Private data is i�famiatzo� lhat gei7erally cannot be given to the public but can be given to the subject of tl�e data. <br />Co�a�i.de���ia� data is i�foi�xlatipn that generally caf�at be given to either the public or the subject of'_'._ data. <br />The Ciry of Roseville is collecting the info���ation to detei�e qualifications to serve r.:� a Citizen Advisory Can�a�ssion_ <br />You are not legally required to provide this i�ox�nat'io�. However, if you do not supply the information, you may not serve on <br />aCitizenAdvisory Coz�a,n2issir��, <br />4tl�ez- persons or entities autl�orized by law to receive this inf�i�nation are Ciry Council n�em�ez�s, staff, residents of Roseville <br />and i�ter�sted others. <br />I unde�'sta�ld that all infaz�na�ioz�provided in tlus application, except m: telephone nun�bers, fax zx�.uiZbe�' and <br />ex��ai1 addl ess, �nay be disl��auted by 1L� City :: tl�� public including, but not Ju�itec� to, being posted on il ��.• <br />City of Roseville va�bszte_ I agree to waive any and all c1ai�77� under .1 i� 1VEu��esqta Govelxu�n.e��t Data <br />Practices Act, or any othez applicable state and fede� aI law, that i i� any way related to tl�.e dissemination to �1 i� <br />public of �f'on��a�ioiz contained � this applicationthat would be classified as private under suc�. laws. I <br />understand �3�at I inay contact t��e responsible auiJ�ority far the City of Roseville if I have a��y questions <br />regarding the public or private nature of the infoz���atzon provided. <br />I ua.�dexstaiad t1�at the City will not publish inyphoile or fax numbers or e���aiJ. address without r:� autllorizat�p�a <br />and do hereby allow the City to publish (check all that apply). <br />home telephone n�r_r-1�.��r <br />�work telephone r.��r_l�ur <br />�,t,:;��s emaz� address <br />wnrk t�ri:;�i� �,1;!:�:?:� <br />. Cf"`��� � �7' . -- <br />5�srnattir� uf Ap��li�.�� <br />,�If}GiYir.Yflxi :1ir{s f <br />- -� � - ��� A �. ��� � <br />Date of �1 Ia. at�on <br />