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t is yot�r vieri� of the role of a member af the 1��r�`s & Re�deve�opmerit A �s��, `/� �s � _ �, ,�re �� Other Comments: (Include anyfu��the�� informatia�z you wauld lzke the Cfty Council to considel� ar that you feel is relevant to the appointment y�ou are seeking: You may also attach ather materials you would ltke the Council to consider.) �/�,��%% /,'/�� y�'� -�,��o Q��p/e � �� 7'ennessen VVarning - Same or a31 the infa�nation [hat you are asked €o provide is classi�ed by State law as either privaie or confidential. Private data is information that generally cannot be given ta the public but can be given to the subject o�' the data. Confideniial data is information that generally cannot be given to either the publie or the subjecE af tfie data. The City of Roseville is collecting tl�e information to determine qualifications �o serve on a Ciiizen Advisory Comrnission. You are nat ]ega]3y required to provide t}tis inforrriation. Howeve.r, if you da noi supp]}r the information, you n�ay nof serve on a Citizen Adv�sory Commission. Other persons or enlities authorized by 1aw io receive this informati.on are City Counci] members, staff, residents of R.oseviile. and inferested ott�ers. I understan� that all informa�ion. provided in this application, except my tele�hone nurnbers, faac nusnber and email address, rnay be disti-ibuted by the City to #he public including, but not limited to, being postied on the City oiRose�ille website. I agree to waive any a�d afl claims under the Minnesota Gavernment Dat.a Prac�tces Act; or any otl�er �pplicable state and federal taw, that in ar�y way re3ated to t�e dissemination to the pn�lic of information contained in this application that would be classified as private tander such. ]av�=s. T understand t}iat Lmay contact the responsib3e autho�ty for the City of Roseville if I have any questions regar�in.g the public or private nature of ihe infarmatian proti�ided. l understand that the City v�rill not publish my phone or % numbers ar email address wit�out my authorization and do hereby allow the City to publish (check al] that apply). �home telephone number home fax number �hame emai] address ?� work t�lephone� numhei- �work fa�c number �v��ark emai] addr�ss other telephone n��nber J understan.d that I inay be invited to an interview by the Cit}� Counci] thaf may be audio or videatap�. _ r- , /`�� .�. �. � 7 � �. �- � - _____ -- S�.gnati�re af Applicant u��: o3.as Date of Application