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1�`II�C ig Y�1] r 4i�1�' �€ ih� rrt�l� «f s �n��ul�c r uf rl�� uu�in g��e��eloptn�o� ��iu �huril��;� Other Comments: {Iszclud� any furtlier i�zforrnatzorz you would like the Mayor and City Council to consider or that you feel is relevant to the appointment you are seeking. You �azay also attach other materials you would like considered.) Tennessen Warning - Some ar all the information that you are asked to provide is classified by State law as either private ar confidential. Private data is information that generally cannot be �ivez� to the public but can be given to the subject of the data. Confidential data is information that generally cannot be given to either the public ar the subject of the data. The City of Roseville is collecting the information to detennzne qualifications to serve on a Citizen Advisary Commission. You are �zat legally required to provide this �£orn�atioii. However, if you do not supply the information, you inay not serve on a Citizen Advisory Commission. Other persons ar entities authorized by law to receive t3�is infonnation are City Council members, staff, residents of Roseville, and interested others. I understand that all information provided in this application, except my telephone numbers, fax number and ema.�� address, may be distributed by t��e City to the public including, but not limited to, being posted on the City of Roseville websrte. I agree to waive any and all claims wader the Minnesota Government Data Practices Act, or my other applicable state and federal law, that in any way related to i��e disseznSna�ao�a to the public of information containedin this application that wouldbe classified as private under suclz laws. I understand t�xat I may contact the responsible authority for 1h�: City of Roseville if I 1�ave any questions regarding the public or private nature of the �.fol�at�o�. provided. I understand that the City will not publish my phone or fax numbers or ��nail. address without my authorization and do hereby allow the City to publish (check all that apply). — IZC��ne telephone number � home ezx�aa� address � work telephone number ��t:r.der�ta�id tha n�a}� T�e ut}�=:s� t� �� ir,�cr4�i -�y ihc C5t v��w�ci[ tl �at may be audio or videotaped. . . ..�.. . . . . _ . . . . ��'�{ �, ��' .�',.�-�- �i ��da�r� �rf p��tti_�� Date of �� I it �� i��i i Updated:09104