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Ot�er Comments: {Inc�ude any, furrher ir:format�on you wou�d like the City Councfl to consider or ti2at you f eel is relevant to re- ap�ointmes�t, You rnay Qlso attach other materials you would 1 ike the Council to consrder.l , . �1 , � Teanessen Warning - Som� or all the informatjon that you are asked ta provide is classified by State i�w as either prsvate ar confideniial, Privatc data is informatian that generaily �annot be given to the pubiie bnt can be given to the s�zbject of the data. Conf dential data is information that general]y cannot be given to either the public or the subjoct of the data, The City of Roseville is callecting the infvrmation to determine qualifications to serve on a Citizcn Advisory Comt»ission. Yau are not iegally roqaired to provide this information. However, ii'you do nat su�rpfy the irrformation, you may.nat serve on a Citizen Advisory Commission. Other persons or entities authorized by law to receive this inform$tion are City Council members, staff, residents of Rosevillc and interesied others, I understand that all informativn pxovidcd in this application, cxcept,my telephone numbers, fax nuzn,ber and email address, may be distributed by the City #o ihe public inclucling, but not limited to, being �vsted on the �ity of Roseville website. I agres to waiv� any a�d a!1 claims under the �Iinnesota Crovern�n�nt bata Practices Act, or. �y ather applic�ble st�te anci fedezal law, that in any way �related to the dzssemination to the public of info�ma.tion contained in this appl�cation rhat would be classified as nrivate undEr sucb laws, i understaud that I ax�ay co�tact tYze responsible authority fox tile City of Roseville if I have any questions regarding the public or private nature of the infortrxation prowided, I undez�star�d that ihe City will not publish m3� phone ox fax numbers or email address wit�aaut my authvri�aation and do hereby al�ow the City to pvblis� (check �11 that apply). Y�ome telephane number work telephon.e �umber �oz�ae email address � �„ . l� � 3 0 Applicant ate of p��ic�tion Applrcariort 091130