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ii'�t� �� wr v�e� v� �e �� d�hi Camm�ssion/CommitteelTask F .� <br />� �r <br />Other Comments: (Includeany further information you would like the City Council to consider or <br />that you J'eel is relevant to the appointmentyou are seeking. You may also attach other muterials ►%ou <br />would like the Council to consider,.) <br />�r �� <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 given to the subjcct of the data. <br />Confidential data is information that generally cannot be given to either thc public orthc 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. }iowever, 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 membcrs, staff, residents of Roseville <br />and interested others. <br />I understandthat all information provided in this application, except my telephone numbers, fax numbcr and <br />email address, may be distributed by the City to the public including, but not limited to, being postcd on the <br />City of Roseville websitc. I a�ree to waive any and all claiit�s under the Minnesota Government Data <br />Practices Aet, or any other applicable state and federal law, that in any way related to the dissemination to thc <br />public of information contained in this application that would be classified as private under such laws. I <br />understand tllat ] may contact the responsible authority for the City of Roseville if I have any questions <br />regarding the public or private nat� of the information provided <br />3 understand tllat the City will not publish my phone or faY numbers or email address without my authorization <br />and do hereby allow the City to publish (check all tllat apply). <br />�nrr�c telephonc number <br />vwark tclephone number <br />____emait address � <br />' ^ �? <br />l'� �� �� <br />Applrcationd�/017 �]€;rsaiwT��AE7y11i��n1 <br />���� �' � <br />Datc of Application <br />