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� ; � <br />What is your view of the role of this Commission/Committee/Task Force? <br />r--�� 1 <br />Other Comments: (Includeany further infomzation you would like the City Council to consideror <br />that you feel s relevant to the appointnzentyou are seeking. Yoa� may also attach other materials� <br />would like 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 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, ifyou 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 all 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 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 />regardingthe public or private nature 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 the City to publish (check all that apply). <br />home telephone number <br />_wark telephone number <br />�P.mail address <br />� <br />� �- <br />� �. <br />51�Lui� pp��aru <br />Application 031017 - <br />� ��• � � <br />Date of Application <br />