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�4'hr � i�. }'ou r Vi�w tf� il�r r���e i i f lf��� �'R�r� muia it} �' i� ii,:: i i� � ti[L� ri ri ��: u r�G�n i[�ee? <br />� <br />Othe� �omtnents: (Ir�Glucle c�TZy fu�tlae� _;�rr,;,�.�;.;:�=•:;; you �ould like the City Council �a co7aaszd�r or <br />thai you.Ieei is rel�vG����� io ���; � a�a-�oir�.t;;ze}��t you � seeking. You n4�y also attach other ��� �??�?;� yo?� <br />=�7-�� � � � � lc'ice if�e i:ourril io consider.) <br />� <br />Tennessen Warning - Some or all the information that you are asked to provide is classified by State law as either private or <br />confidential. Private data is information that generally ca�lot be given to the public but i?' = be given to the subject of the data. <br />Coiz�dcxztial data is infarn�ation that generally cannot be given to either the public or the subject of the data. <br />Tlze City of Roseville is cal�ecti��g the information to detern�e qualifications to serve on a Citizen Advisory Coiruzzissinn_ <br />You are not legally requi�ed to provide tlus information_ However, if you do aiot supply the information, you may not serve on <br />a Citizen Advisory Con�nission. <br />Other persons or entities authorized by law to receive ',: ��ifa1-rr�atiol� are Ciry Gouzacil members, staff, residci�ts of Roseville <br />and interested others. <br />1 understand tl�at all i�1f'orzaaatioza provided i�i this application, except n�y te�ephoz�e nuz�3bers, fax ���l2nber and <br />email address, �nay b e distributec� by the City to the public including, but not 1�rnitec� to, bei�7g posted on :1 i� <br />City of Roseville websiLe. I agree to waive any a��d all claul�s under the NIi��7esota Govei����e��t Data <br />Practices Act, or ai�y o��her applicable state and federallaw, that in �t� way related to the dissenu�atiorl to tlZe <br />public of i��foi��aatian contained in il�is application that would be classified as private t�nder such Iaws, I <br />understand that I��Zay contact the res�ai7sible authority for :1:�: City of R�seville if I have �11y questions <br />regarding the public �}r private nat�u � of t1�e infonnati�n provided. <br />I understand tl�at the City will not publish m�.' ��l�one or fax 11ui�l�ers or elr�ail addr�s� without my authorization <br />and do hereby allow the City to publish (c�Zeck all that apply). <br />hollle telephone number ���t�r� telel�lzone za�ainbel- h o m e enaail address <br />�.�,��.r�: e���ail address <br />Si��ature of Applicant Date o�' Applicatioi-� <br />Jy��,�sri�•��_CS�.�::-. , <br />