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Other �omme��t5; (u��iude any furtlaex' infonnatioa� you would like the City Council to consider or <br />that you feel is relevant to �IZe appointment you are seeking. You may also attach other materials <br />you would like i�� Council to consider.) <br />Te���ss�z�. Warning - Some or all t�z� information that you are as�tec� to provide is classified by <br />State law as either private or confidcntial. Private daia. is in#'ormatiou that generally caiulat be given <br />to the public but ti �� be given to the subject of the data. Co fidential data is information that <br />generally cannot be given to either the �u�lic or the subject of the data. <br />The City of Roseville is collecting the information to determine qualifications to serve on a Citizen <br />Advisory Commission. <br />You arc not legally required to provide this information. H�wever, if you do not supply the <br />informatian, you may not se�ve on a Citizen Advisory Commission. <br />Other persons or e�tities authorized by law to receive this information are City Council members, <br />staff. residents of Roseville and interested others. <br />I�n€iezs�a��� that all 'z�faa�z�atinn provided 'm this application, except my telephone numbers, fax <br />number and ez�ai� address, may be distributed by the City to the public �ncl�zdi�g, but not limited <br />to, being �;es���� ^�:� ihc ��t�,� of r t, �c•: iZ]� ��vet���4e. i µ��Le ��, :. �i :-;� ar�y � all �l;;;rr.� under � �;, <br />Minnesota Government Data Practices Act, or any other'applicable state andfederal law, that in <br />aary way related to the dissemination to the public of information contained in this application that <br />would be classified as private under such laws. I understand il«r� I may contact the responsible <br />authority for the City of Roseville if I have any questions regarding t�a� public or private nature of <br />the information provided. <br />I understand t��afi the City will ��ot publish my phone or fax numbers or email address without my <br />authorization �nti� do hereby allow the City to publish (e.l�eck all that apply). <br />x�o�ne telephone number w o r k telephone ��umber h o m e ezrkaa� address w o r k email <br />address <br />Si�lafura of Applicant Date of Application <br />� � � <br />��. � � � <br />Application— CV_04110b <br />