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TENN�ESSEN WARNING <br />In connection with your application for appointinent to a board or comniission the City has asked <br />that you provide it with information about yourself which is classified as either primle or evqfidenlial <br />by the Minnesota Government Data Practices Act (NIS 13.04). Accordnilgly, 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 Mifort-nation requested includes the following: additional conlaa <br />infoiwialion on Me sapplemenial applicalion proiided iu order.1brs1qj1'10 nacb, you. <br />1 The purpose and untended use of the information requested is: lair ( , y Council and slqffreiVe it, and <br />prwess-lyour applicalion. W'6, ivill alvo need the i�i ovvalion if "you ai v appointed in orderfir-you Io peijorlv in <br />_your role as a board nieviberl cop1missioner. <br />4. You are not required to, supply the requested information. <br />.5. The known conseq Liences of refusing to supply the requested information is: delay, in nol# hg, you <br />and.s-(!ndii7g iulonvalion lojou thal is ihiporleml to perfbmi-your dulies as a board <br />6. The following persons and entities are authorized by law to receive the: inform. ation if provided: <br />Couna'l sand slqff'aPhoxe work- asszgnnienls requin? ace-ess. <br />The undersigned, by signing this notice, acknowledges that he/she has read and <br />understands the contents of this notice. <br />/ - <br />Date <br />Slignature of Applicant <br />INV-,\ A C C r s"' C <br />Print Narne <br />