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2004_0120_Packet
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2004_0120_Packet
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Please state vour view of the role ofthe Citv Council: <br />r'� � �� � � SG� Gt�G r,� �-�rr�- <br />Other Carrnents :(Includecmy further infomationyou would like the City Council to consider or <br />thatyoufeel is relevantto the appointmentyou are seeking. You may also attach other materialsyou <br />would like the Council to consider.) <br />� C�� r� <br />Tennessen Warning • Some or all the information that you are asked to provide is classifiedby State law as either private or <br />confidential. Private chta is information that generally cannot be given to the public but can be given to the subject of the data. <br />Confidential data is informationthat generally cannot be given to either the public or the subj ect of the d�a <br />The City of Roseville is collecting the information to determine qua.lifications to serve on the City Council. You are not legally <br />requiredto provide this information. <br />Other persons or entities authorized by law to receive this information are City Council members, staff, residents of Roseville <br />and interested others. <br />1 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 tn, �ei,t�g poste� on the <br />City of Roseville website, I agree to waive any and all claims under the Minnesota GovernmentData <br />Practices Act, or any other applicable state and federallaw, that in any way related to the disseminationto the <br />public of information oont�ii�ed in this application that would be classified as private tux3er such laws. I <br />understand that I may contact the responsible authority for the City of Roseville if I ha�e any c�stiazs <br />regarding the public or private nature of the information provided. <br />I understand that the City will not publish my phone or faY numbers or email acldress without my authorization <br />and do hereby allow the City to publish (check all that apply). <br />h o m e telephone number <br />work telephone number <br />�emaif address <br />��-��� I-9-04 <br />' Signature of Applicant Date of Application <br />Aaar;�n� o.�oroiQ <br />
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