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Cilty 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 staff to reach you. <br /> 3. The purpose and intended use of the information requested is:for City Council and staff to review <br /> and processyour application. lie Pill 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 ' not�ingyou <br /> and sending information tojou that ' <br /> s important to performyour duties as a board rnernber/cornrnissioner. <br /> 6. The following persons and entities are authorized by law to receive the information if provided: <br /> City Council and staff P)hose Pork 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 /> July 10, 2017 <br /> Date Signat�re of Applicant <br /> Rhonda J. Magnussen <br /> Print Name <br />