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�� F�:�i i4 3'ritrr ��C'��• �ai' t h�� rri f �� I' t fi �� 'ri m re�a�rri� t• �� X�ea��iri �,ti! ��•i•�r�;� �'saaa i hr]i I��': ..., - �%�prk tn i�Pntifv��nntPntial R77�"]GnTI'J,�J'111tf',eC - Participate in the selection of subCp�nrnittee members - Act as a liaison betvyeerl the subcoin�nittees, counCil, and staff Other Comments: (Include any further i�zfo�rnatio�2 you would like the City Council to col�a�ider or that you feel is relevant to ih.e appoint�aze��t you are ��.�:�� it. You may also attach other mate�°inls you �a��ld like the � z��z7rr�� to c�:asid�r.) . �'euaessen �'Uarning - Some or all the infonnation that you axe asked to provide is classifiedby State law as either private or confidential. Private data is informationthat generally cannot be given to the public but can be given to the subject of the data. Cot�ide�tiai data is in_foxrnatio� that generally canuot be given to either the public or the subject of the data. The City of Roseville is collecting the i�nf'orn�atio� to detetmine qualifications to serve on a Citizen Advisory Coxnnusszo�. You are not legally required to provide this it��o�n�ation. However, if you do not supply the information, you may not seive oi� a Citizen Advisory Caz�ln�ission. Othev persons or entities authorized by law to receive tlns information axe City Council members, staff', residents of Roseville and interested othei�s. I u17,d,crsta�ld that alI info�n�atioa7, provided in this application, except my telephone numbers, fax number and email address, may be d�stt`ibuted by the City to the public including, but not lir�-ait�d to, being posted on the City of Roseville webszte. I agiee to waive any and all G�aims under the Minnesota Government DataPractices Act, u� any other applicable state and federal law, that I`] any way related to the dissemination lo the public Q�information contained in this application that would b e classified as �rivate under such laws. I understand t��at I may contact the �-espoi�sible autl�o�7ty for the City of Roseville if I have any questions'-i,t�'-�T'� � �� the public or private �a�lzre oFt�le ��Zforrnalion provided. I tv�ldez�staud tl�at the City will not publish my �?l�ane or fax numbers or ei�ail �ddress without my authorization and do hereby allow f.�ie City to publish (check all t��at apply). IZOn�e 1�.::��l7nit4 �i�im�it� ._kti�,�rk telephone zauinbex hoine eia�.ail address �uorl� eii�ai� ac��ess � F , � � . � 1 � �—r - ,. - 1 � ��'T � r �'-��T�.�� •.�'_�. •�,. � — -�i!�ii�i.ir;: ofApplicant Date ofApplication �_..;x�� 'S�