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��' I�71� ��fFkY Y� li"4F' �1 � I �'kl` ��alc frf ta�� .+ym n� iin i�3� �� i�itEn�n �, �I�x�ri�1� ��n11�� I f��c ;' -—- -- -- -• - • - _ _ . _ — - - - • - -�� ��, . 'Y�� r w � .� _ � . � ,,._ � � L.. � �� .� � y � — �'= � ,x� ' -- �� ,�� f}_�,F y� � � _ (} – – r. � 1 y � � .7 _. � . _ .4 � � 71 . . — -.`5 � `3� .—�~�'�`s� � �r-�- �� �� . •.� � - r �� J�� ;'��.�; Other Comments: (Include any further infor°n�atian you would like tF�e Cfty Council to consider or � thai yau feel 4s ��e�ev�nt t� ;;; i� a�apointr��e��t �.•r�+1 are seeking. You r�z�y also attach other nzaterials you would like the Council to consider.) ___ __ Tennessen Warning - Some or all the %z�foxmatio�i that you are asked to provide is classified by State law as either private or confidential. Private data is informationthat generally cannot be given to fhe public but can be given to the subject of the data. Confidential data is information that generally caau�ot be given to either the public or the subj ect of t1�c data. The Ciry of Roseville is collecting the information 9� determine 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 Camtz�issio�a_ Other persons or entities authorized 1�' law to receive i�i i�• z�forination are City Council members, staff, residents of Roseville and interested others. I understand that all izifoi73�atior� provided in this application, except my telephone numbers, fax nw�i�ez and e�az� address, may be distributedby the City to the public including, but not Ia�nited to, being posted on the City of Roseville website. I agree to waive a�2y and all claims under the Mir�esota Government Data Practices Act, or my other applicable state and federal law, that in �n3• way related to �`�� disse:t�ation to the public of information contained in tI�zs application that would be classified as private under such laws. I understand that I may contact I] is- responsible authority for the City of Roseville if I have any questions regarding the public or ��vate nature of the ir.�£o�zatiq� provided. I understand that the City will not publish iny phone or fax numbers or einail address without my authorization and do hereby allow the City to publish (check alI that apply). home telephone number work telephone nt,�ber �I�c�me email adciress w o r k eznail address Signature of Applicant Date of Application y�i�ir.:�:141 4�' yli':�i� i — '- I