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H�w ��a }�our �ie�t of t�� role o�thi� ��mmis�fpa t��n��d si�ee �a�ur firat t�rm� <br />r.. . r . � _ ' <br />�# �q rn�� <br />_x_ ,��-��� _ _���.r r � � <br />�_. v_.. y.___. <br />Other Comments: (h:clude a�rl� fi�rther ii formatia� you would like tf�e City Council to consider or <br />thut you feel is relevant to re- appointmen� You mqv also attaclt other materials you would like ��r� <br />C'ouncil to consider,) <br />"1'ennessen Warning - Some or all the inforrnation that you are asked to provide is classified by State law as either private or <br />confidential. Private data is information that generally cannot be given to the public but can be given to the subject of the data. <br />C�onfidential data is inforrnation that generally cannot be given to either the public or the subject of the data. <br />'I`he City of Roseville is collecting the information to determine qualifications to serve on a Citizen Advisory 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 Citizen Advisory Commission. <br />Other persons or entities authorized by law to receive this information are Ciry Council members, staff, residents of Roseville <br />and interested others. <br />I understand that all information provided in this application, except my telephone numbers, fax number and <br />email address, may be distributed by the City to the public including, but not limited to, being posted on the <br />City of Roseville website. I agree to waive any and all claims under the Minnesota Government Data <br />Practices Act, or any other applicable state and federal law, that in any way related to the dissemination to the <br />public of information contained in this application that would be classified as private under such laws. I <br />understand that I may contact the responsible authority for the City of Roseville if I have any questions <br />regarding the public or private nature of the information provided. <br />I understand that the City will not publish my phone or fax numbers or email address without my authorization <br />and do hereby allow the City to publish (check all that apply). <br />�home telephone nurnber <br />��� work telephone number <br />�email address <br />_--, <br />�•{-�-. � - <br />��k��� �F rlppti�l <br />�i�rw �K,v �: <br />�� <br />�t� � A�li��li�� <br />