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t • <br /> of <br /> TENNESSEN WARNING <br /> River^�--- APPLICATION FOR APPOINTMENT TO CITY <br /> BOARD OR COMMISSION <br /> In connection with your application for appointment to a board or commission the City has asked <br /> that you provide it with information about yourself which is classified as either private or confidential <br /> by the Minnesota Government Data Practices Act(MS 13.04).Accordingly,the City is required to <br /> inform you of the following. <br /> 1. Residential address,telephone number,and email address are private. Once appointed to a <br /> public body,the data becomes public. <br /> 2. The private or confidential information requested includes the following:additional contact <br /> information on the supplemental application provided in order for staeto rack yon. <br /> • <br /> 3. The purpose and intended use of the information requested is:for Ci y Council and staff review and <br /> processyour application. We will also need the inirmation#:you are appointed in orderforyou to perform in <br /> your role as a board member/commissioner. <br /> 4. You are not required to supply the requested information. <br /> 5. The known consequences of refusing to supply the requested information is:delay in notifyingyou <br /> and sending information toyou that is important to perform your duties as a board member'commissioner. <br /> 6. The following persons and entities are authorized by law to receive the information if provided: <br /> City Council and staff whose work assignments require access. <br /> The undersigned,by signing this notice,acknowledges that he/she has read and <br /> understands the contents of this notice. <br /> - • 7'' AAlrA., <br /> Date S.`, .tur- ofSp•,i <br /> ftietrAfpgjig3,. <br /> Print Name <br />