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���7�w� i� our vi�►r� ofti�e r�l� r�l'ihi� �"uu�rrnx�ioa'�"uuu��lie�i��if F�rc�? <br />_.�.------- --- -- � -- --- - -- . . . - � - - - <br />1_ - ':'r �; s �'f� � i �' � J•' .��'.• : r; �r . <br />4� <br />�tl��: Comments: (Includeany furtl�er information you would like the City Council to consider or <br />thcrt you feel � relevant to the appointment you are seeking. You may also atiach other materials you <br />would like �he �ounci7to consider.) <br />� /t�'.� -Tr.: r ���{'.r� �� <br />'r'ennesse� Warning - Some or all the informationthat you are asked to provide is classified by State law as either private or <br />confidential. FR�'�1� data is informationthat generally carnlot be given to the public but can be givento the subject of the data. <br />Confidential data is izafar�axatio�� that generally ca�u�o� be given to eztl�er 1�e public or #lec subj ect of the data. <br />The City of Rosevilleis collecting the ir�orma�ioTT to detetmine qualificationsto serve on a CitizenAdvisory Commission. <br />You are not legally required to provide this information. However, if you do not supply the information, you may not serve on <br />a CitizenAdvisory Can�r�uss€n�. <br />Other persons or entities authorized by law to receive this informationaxe City Council members, staff, residents of Roseville <br />and interested others. <br />I understandthat all informationprovided in this application, except my telephone numbers, fax number and <br />am� address, may be distributed by the City to the public including, but not limited to, being posted on the <br />City of Rosevillewebsite. I agree to waive any and a11 claims under the MinnesotaGovernment Data <br />Practices Ac�, or any �t���r applicable state and federal law, �i� in any �•��- related to the disseminationto t5e <br />public of information contained in this application that would be classified as private under such laws. I <br />understand 1�7;�� � may contact the responsible �uii�orit� for the City of Roseville if 1 have any questions <br />���::rcL�� the �u'��z� or privatenaiure of tf�e infonnaiionprovided. <br />I understandthat the City will not publish my phone or fax numbers or erna�l address without my authorization <br />and do hereby allow the City to publish {check ull that apply). <br />��om� telephone number <br />work telephone number <br />�ho�e eznaii address <br />����rl: �m4�: s�][lr e�3 <br />.�,�,�,o osar� <br />�f�pli��rrt <br />� � � <br />� <br />���� ��� <br />-- L��r� ��f ���i����,n - - <br />