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APR-19-2006 WED 08;32 AM FAX N0, P, 03
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<br />T�y�������, �F�rain�- Some oi�l the infonnatiQn that you are �slced to grovide is classified by State ;=�' as eithor private or �
<br />cori�cientihl. Private data i s infot�7aation tk��t generaiiy cannot be given to the public but can be given to the subjc�i c� i` iiie data. "�
<br />Canfidential d�CZ is information t11�t ;��=a:lr• cannot be given to eitl�ar thc public or the subject of tllc data. ���
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<br />T1u. City of Rose'ville is collecting tlae information to detel'mitte qualific�tions to 3ei'v� on a Citizen Advisory Cornmission.
<br />You are not 10 a.11 re wred to rovide �h:z infozz�al.tio�1, T°To�vaver if ott do not su 1 the information, ou ma not serve ��
<br />€� �' 4 P � Y AA Y Y Y �����+�''
<br />a� i ii'r�•r. Advisary Commission, �����
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<br />dCI�eC persons or entiiies authorized by �aw to recuivc t'his infortnatiotl are City Council mem$ars, staff, rasidents ofRo�eville
<br />nC��' interestedothers.
<br />I understancl that all infQa�nat;o�� pro�viaed in this application, except my telephone nu�nbers, fax nurnbet' and
<br />e�r��i1 address, may be dislz'ibut�d by t:he City to the public including but not limited tq beu�g postccl on the
<br />City of Roscvillc website, � agree to ���ai'�t; any �,n�l all �laiins � �; �1jtiT t,�C MinnesotaGoven-�nenC Data
<br />I�r.�ctices Act, or any other applicable s1:atc and federal law, th�t m any way related to tl�e dissemination to the
<br />p�sbCi� of iilfarnia.tion contained 'u� t11is applieation that would be claesif ed as private under such laws. I
<br />wtdas�d that I may contact the responsiblc authority for t1�e City of Rascv�ill� if T I w ti•� any �p ir.��;n�7s
<br />�•e�;�$in� �e public or private ;:.7ri �i � of the information provided.
<br />I understand that Che City will not publish my �hone or fax numbe��s or eniail address without x�y authorization
<br />and do liereby allow thc City to pub�isl� (check a11 that apply).
<br />✓ lla�n� C�lephonc ntiunbe��
<br />�� celephone number
<br />*=%om�mail adciress
<br />—_work ernail address
<br />� ��tj����,
<br />Signature of Applicant Date of �pE�.��;.:i i� .�
<br />•�,d,�fYsn osvs:.>3
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