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�1e�e a�fieya�v r4aero�m #or w�ie� I�ser�e �e th��������� ��.�e: <br />��e� b� �rs spec��� �spc�i�� - �s�e a�ddr�rsad �J�t ��A,��,��;� <br />� r.� � � k � �t �x� '�'a �x � .f .� �����r�� �a �� �.,� <br />���.���vv �r� �.��r� v� �-�i � �o� � �w�� �_ � r�t� ffv� <br />�� <br />�.�,��*�la r-��i�N �� j�� �r �1 rr � .:� _ �,r�r��.i � ����.� �. .�,�, <br />�rr� r�� ��r�7' ��i � �r �rr �, �f r �� �r rt � O� �d .d � �r��� r.�� o r4 <br />� ' . <br />- X!� i kr I i�, � � � � <br />�. XF .S T � 1�P'1M � � � J' C � O � JVJ� .�C � �� £ f�+�� � � � � ,I�A�.I <br />�l►1 �l �'' � if � 6 ��" rF �S � � �T if #�r 4K , <br />� <br />��� � }'�� �� � � 1"4i! � �! ��+IIRI�d�D���#8�[ ��I�C�� <br />� �, �� � � �1 � �'��� r�� � o r � � . C�n±�,•� rlxs rr..r � � �,.� � � � ������ � <br />- �.-.�:• -�� <br />1_=i T,�' �•��3 ��� r+ . fJ.iR�� �1'�'T/!�V � _ �' iJ,�i..e. +J }�� � �• �b'/i� J� �' � <br />�� �e►�n.i������+r� �r ��r��� �vo���.c�u� �.�s�� owF �rf �x <br />._��C���_ .. .. �._. _.. ..._. _ . _— .. ._ � <br />Other Cam�ts :(Include ar�rfurther inforn�tionyou would like the City Council to consider or <br />thatyouf�l is relevant to ther�pvr��you are sgeidl�. You miayalso attach other��s y+ou <br />wbuld like the Council to consider.) <br />Tennessen Warniog - Some or all the information that you are asked to provide is classifiedby S� law as eitherprivate <br />or confidential. Private data is information that generally cannot be given to the public but can be given to the subj ect of <br />the c�ta. Confidentialdata is infora�ation that generally catmot be given to either tl� public or the subject of the data. <br />The City of Roseville is collectingthe information to determine qualificationsto serve on a Citizen Advisory Commission. <br />You are na�� required to provide this information. However, if you do not supply the infi�mlation, you may not serve <br />on a Citizen Advisory Commission. <br />Other persoos � eutities autliorized by law to receive this information are City Council members, staff, residents of <br />Roseville and ir� others. <br />I understand <br />* This applicationis public informarion, <br />* I will be im�ited to an interriew by ti�e City Council that may be audio or video ��1. <br />. This applicationmay be discussed at apublicrna�r�g. <br />� �#^�-� 6' - /'7' - 4 01 <br />Signature ofApplicant Daie ofApplication <br />�r����.,� Ye��b5�7,�� <br />