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Te�essea Wat�iag - Some or all the informatian tl�at you are asked to provide is classified by State I aw as either private or confidential. Ptivate data is infprmation that generally carmot be given � the public but can be given to the subjectof the d�a. Confidential data is inforcnation that generally cannat be given to either the public or the subj ectof the data. The City of Roseville is collecting the infostnation to detem�ine qualificatiaus to serve on a Citizen Advisory Commissian. You are not legally required to provide this informadon. However, if yau do not supply tbe infn�nati�, you ri7ay not servc on a Citizen Advisory Commission. Other persons or entities authorized by law to receive this information are Ciry Council members, staff, residents of Roseville, and interested others. I understand that all information provided iar this application, except my telephone numbers, fax nutnber aald email address, may be distr�`buted by the City to the public including, but no� limited to, being posted on the City of Roseville website. I agree to waive any and al I claims under the Minnesota Govemment Data Practices Act, or any �i}rGr applicable slafie and federal law, that m any way relatedto the dissemination to the public of inf�tr�ation contained in this application that would be classified as private under such laws. I understand that I may contact the responsible authority for the City of Roseville if I have any questions regarding the public or private nature o f the information provided I understandthat the City will not publish my phone or fax numbers or email address without my authorization and do hereby allow the City to publish (check all that apply). �home telephone number emait address — work telephone number I understand that I may be invited to an interviewby the City Council that may be audio or videotaped .i ;: L� �� Signature of Applicant ��'� ��. Dat� o�A�dhcat�on