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�Yha�t ��ous Yi�w oi the rnl� � t�ls Commi��m�+€'awrNtt�Cas3c ��e? Other Comments: (Include any further infornzation you would like the City Council to consider or that you feel is relevant to the appointment you are seeking. You may also attach other materials you would ��r�• the Council to consider) Tennessen Warning - Some or all the information that you are asked to provide is classified by State law as either private or confidentiaL Private data is information that generally cannot be given to the public but can he given to the subject of the data. Confidential data is information that generally cannothe given to either the public or the subject of the data. The City of Roseville is collecting the information to defermine qualifications to serve on a Citizen Advisory Commission. You are not legally required to provide this information. However, if you do not supply the information, you may not serve on a Citizen Advisory Commission. Other persons or entities authorized by law to receive this information are City Council members, staff, residents of Roseville and interested othen. I understand that all informationprovided in this application, except my telephone numbers, fax z�u�t>er and etnaal address, may be distributed by the City to the public including, but not limited to, being posted on the City of Rosev�l�e website_ I agree to waive any and a� claims under the Minnesota Government Data Practices Act, or any other applicable state and fedezal law, that in any way related to the dissemination to the public o finformation contained in this applicationthat would be classified as private under such laws. � understand that I may contact the responsible authority for the City of Roseville if I have any questions regarding the public or private nature of the informationprovided. I understand that the City will not publish my phone or fax numbers or e�ail address without my authorization and do hereby allow the City to publish (check all that apply). �hame telephone number wark telephone ntainber home enna�l address wark ema�l address -� �y++++�� •� ,� S]o �fku� �f }4 ,4ppltcat€on OSD523 Date of :� p�i3utt1�11 F 4�_ �