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� . ... j`�f YJLiI w ��€ C�� � �i119 �9lMD11iSlQ �€ ■'�+J� � <br />,� �� <br />Other Comments: (Includeany further informahon you would like the City Council to consider or <br />that you�eel is relevant to the appointinentyou are seeking. You may also attach other materials vou <br />wouldlike the Council to consider.) <br />�� <br />Tennessen Warning - Some or all the information that you are asked to provide is classified by State law as either privatc or <br />confidential. Private data is information that generally cannot be given to the public but can be givcn to the subject of the data. <br />Confidential data is information that generally cannot be given to either thc public or thc subject of the data. <br />The City of Roseville is collecting the information to determine qualifications to serve on a Citizcn Advisory Commission. <br />You are not legally required to provide this information. }lowever, if you do not supply the information. you may not servc on <br />a Citizen Advisory Commission. <br />Other persons or entities authorized by law to receive this information are Ciry Council membcrs. staff, residents of Roseville <br />and interested others. <br />1 understand that all information provided in this application, except my telephone numbers, fax numbcr and <br />email address, may be distributed by tkie City to the public including, but not limited to, being posted on the <br />City of Roseville websitc. I agree to waive any and all claims under the Minnesota Govemment Data <br />Fractices Act, or any other applicable state and federal law, tkiat 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 a may contact the responsible authority for the City of Roseville if I have any questions <br />regarding the public or private nat�are of the information provided <br />I understand that the City will not publish my phone or fax numbers or email address without my authorization <br />and do hereby allow tkie City to publish (check all that apply). <br />humc telephone number <br />war4c tclephone numbcr <br />_cmail address , <br />r�.� <br />ApplicuJian 031017 <br />Applicant <br />����� � � <br />Datc of Application <br />� <br />� <br />E <br />- <br />� <br />