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��'9�;� I i� 3���u r 3�i��r}� u]' f�� � ri� It s��� [l� t(. �f��� �riut� il ti: �-isi+� �11ua .�� ��t'iva [_� Fr�M n i il tct': <br />� -. ti• . . . .. • <br />.. � L, '� '_" k�. �•.. ' . ' - . .�r• f L �_1�i . ��'" i�_ �� •f..l� r'L l� � yJ 1M1 L <br />� � � . ' � <br />� ' <br />• ��� ' I � � •, �l{ , �= <br />�. k'._ ��..���.��—��..�����_ `_"""� "_ " "��� ""�.� "'" ""_�` """ " r <br />� S'L ■. 4 �S ��2 �i�y L-- � k ��� i •3 }I� �`�4^'y �.�w �._�t �r-y� �J.�� rs� a�fti -1 4_r �� � •` It_� <br />� • ..+ } <br />�y�_Ly� t' '`c� i� ��ti �� 4 1-„ ry S LI�.' L ���,� , y,}�w; i. t�r- �. �=7C��s -�_ r' �-1,-•r` I} ,�i_' _:���C }+ 1�.a- <br />.. �__. _ ... . _ ... .-.. _—_ '�._ ...'�__"' �. . <br />_i�*in�_ ti•� �'�`f � �ti+.�L� ��_ y°'S � � i�'� '�� �.--.i� }+�'� �.,y j���• � �...� s•t-,r L � �. � t �� s <br />�' <br />' � � � �U� t�� S a � ,�. . 3 �-�s.� « i�� t�-� � 1.� �'�-,� � w_..�.��.� 2-r�w�n � t i.u� � �� � a�'c I <br />•�,'�. �--- —�.•:i�L <br />. � . . , _ � � �. i _ �1- - - - - <br />� � ?�11w �'+..Y v. � S� r r�- �S. 4L�� � � Li. rl - �-+��"+� � �•-� `�' F •� �.i'� �'-'�ru� {f.i� � � �� <br />�- --_ <br />L L�5,� . � <br />��.I � �1. � - 1 r �y . �' I • •� L L� +t �M1 L L'� I � . _ . _ . _. <br />Other comments: (Include any fi�r�ther informationyou would like the City Council to consider or <br />that you feel is relevant to the appoit�iraierztyouu are seeking. �ou 1�zc�,y also aaluch oth�r� .�_�; r�r�� ����'� you <br />would like the Council to consider.) <br />Tennessen Warning - Some or all the infonnation that you are asked to provide is classified by State iaw as either private or <br />confidentiai. Private data is inforniation that general2y cai7uot be given to the public but can be glven lo the subject of the data <br />Confidential data is info�'�atior� that generally cannot be given to eithe�' ;f7a public or the subject of the data. <br />The City of Roseville is coilecting the information to determine qualifications lo serve on a Citizen Advisory Commission. <br />You are not legally required to provide this infor�nation. However, ifyou do not supply t��� information, you may not serve on <br />a Citizen Advisory Commission. <br />Other persons or entities authorized by law to receive this information are City Council members, staff, residents of Roseville <br />and interested others. <br />I understand that all i�%r�nation provided in tlus application, except nZy telephone numbers, f� number and <br />4�n�Fl� address, �x�ay be c��s�il�uted by the City to tl7e public including, but not limited to, being posted on the <br />City of Roseville wa�siie. I agree to waive any and all claims �.ulder the Minnesota Government Data <br />Practices Act, or any other applicable state and federal law, that in any way related to the disseminationto ihe <br />public of information contained in tlus application that would be classified as private under such laws. I <br />understand that I may contact the responsible authority for the City of Raseville if I have any questions <br />regarding Il �,� public or private i�iuz e of the i�l%1-�na� ion pzovidet�. <br />I understand tl��€t the City will not publish m;: phone or f� numbers ox� email address without m�' authorization <br />and do hereby allow �':� City to publish (check ail that apply). <br />,�� � home telephone �1L�x�ber w o r k telephone number :� L•; : i7i _: e���ail address w o r k email address <br />'r� � , � J� <br />Signature of Applicant <br />:tin-••�:���,:� c�_o�iio� <br />y������ <br />Date ofAppIicalion <br />