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TENNESSEN WARNING <br />`-�'� APPLICATION FOR APPOINTMENT TO CITY <br />ver 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 eitherprivate 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 staff to reach you. <br />3. The purpose and intended use of the information requested is: for City Council and staff review and <br />processyour application. ile will also need the information ifyou are appointed in order foryou to perform in <br />your role as a board memberlcommissioner. <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 not�oingyou <br />and sending information to you that is important to performyour duties as a board member / commissioner. <br />6. The following persons and entities are authorized bylaw 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. c - --- I <br />Date <br />Ct /0 <br />Print ame <br />