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��'b�l �s ��aur rie�� ��� the er�le nf thi5 �=nT�l r�k��inr��'o�I1Mi�tee�T��k Fo�'' ��j l� �� <br />r i _ ■ . _ _ a --- '— <br />�+� <br />��� � <br />�hcr �mm�ats; {fn��en�� a�}���e� i��rrrlraat�nve }+r�u <br />thatyou feel is relevant to the a�u�+�+�oe�dy{xr are seeldn <br />._�. <br />� <br />h�p1l� �l�if� d�hE ���� ���� � �O�JS#G�� 0� <br />g. You may also attach other materials you <br />Tennessen 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 a Citizen Advisory Commission. <br />You are not legally required to provide this information. However, if you do not supply the information, you may not serve on <br />a Citizen Advisory Commission. <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 />I understand that a11 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 to, being posted on the <br />City of Roseville website. I agree to waive any and a11 claims under the Minnesota Government Data <br />Practices Act, or any other applicable state and federallaw, that in any way related to the dissemination to the <br />public of information contained in this application that would be classi�ied as private under such 1aws. 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 wi11 not publish my phone or fax numbers or email address without my authorization <br />and do hereby a11ow the City to publish (check all that apply). <br />�%` home telephone number <br />work telephone number <br />�email address <br />������ <br />Si�t�u�e �f Ap� ��t Date of Application <br />ar�r��n �;ton <br />