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t <br />Ple�.�e �Ca�� +}�ur ►�i�w �� [h� t�Jt ��'th� �il�' �:oUn�il; <br />_ tt� � o,-� �-�[ � � fi t� � � _���r,rr � + � � +� �,�'7+ J� �✓1 �r t� � �' �' �o f'7 � �C � <br />00 �� l�a� �� � � - �,��1��1� �� ��� <br />� F �� � � * + '� � r�.� .� � � 1� �, r � � r d L � <br />Other Comments: (htch�de nrryJ�l7her irrforn2atio�i you ►voi�ld like the City Council to consider or <br />that youfeel is relevnrrt to the appoin[nrent you �r�'� seeking. }�xr a�r�� G� also attach other n�atericrls you <br />ivoi�l�l like the Cotarcil �� consider.) <br />l ��, �� �� � � sb T �v� �� �1 � !� x-��J A ��� x � � � � <br />�� � �� <br />'I�ennessen Warning - Some or all the information 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 />Confidential data is information that generally cannot be given to either the public or the subject of the data. <br />The City of Roseville is collecting the information to determine qualifications to serve on the City Council. You are not legally <br />required to provide this information. <br />Other persons or entities authorized by law to receive this infarmation are City Council members, staff, residents of Roseville <br />and interested others. <br />I understand that all information provided in this application, except my telephone num�Ers, 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 agreeto 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 en�ail address without my authorization <br />and do hereby allow the City to publish (check all that apply). <br />_home telephone number <br />,work telephone number <br />email address <br />�t n <br />�� � ,_ �� �: �_ r � <br />Signature of Applicant <br />Applicntio�z 040/0!n <br />��� � � <br />� Date of Application <br />