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<br />i ennessen Warning - Some or all the i�iormaiian �iai you are asked to provide is classified by �taie law as e2zher �rivate or
<br />confidential. Private data is iz�formatian that generally cannot be given to the public but can be given to the subject af il�e data.
<br />Confidential data is int�orrnataan :l,sl generally cannot be given to either the public or the subject o� #he data.
<br />The City of Rose�i�le is collecting the information to determine qualifications to serve on a Citizen Advisory Con�nission.
<br />You are not legally required to provide this infoTmahon. However, if you do not supply th� iufor�nation, you may not serve on
<br />a Citizen Advisory Commission.
<br />Other persons or entities authorized by law to receive this iriforn7atio� are City Counci� nlembers, staff, residents of 1Zoseville
<br />and interested others.
<br />I understand that all inf�l�x�ation provided in this application, except my telephone nur�bers, fax number and
<br />einail address, lna� be dietiil�uied by the City to the public including, but not lin�ited to, being posted on the
<br />City of Roseville website. I agree to waive any and all claims u��der tl�e Mit�lesota GovE��zei�t Data
<br />Practices Act, or any other applicable state : r �� L federal law, that i��. any way related to .1 i� dissemination to the
<br />�ubiic of in��n�-�afion contained:�i i�:i,� �.�J�311C�����A Lll¢L WOUl� Vei C+I�SS1J1Gd as private �::=��r such laws. I
<br />understand that I may contact �1 i v responsible authority for the City of Roseville if I1�a�re any questions
<br />regarding the public or private nature of the irt�o���-�ation provided.
<br />I understand that the City will not publish rr. Y phone or fax numbers or �mail address without m�• autl�oilzatioi�
<br />and do l�erei?y allow tl�e City to publish {clieck all that apply).
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