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. . . Applicant Information Full Legal Name of Each Solicitor: Known Aliases: Has applicant ever been convicted of any crime? Yes No If yes, please explain: Description of vehicle which the applicant v.ill use while engaged in the business of a peddler or solicitor within the City of Arden Hills: Year Make Model Color License No. State of Issuance: I hereby authorize and grant my informed consent to permit you to release to and make available to the City of Arden Hills, Minnesota, and/or its agents and/or representatives data classified as private which concerns me and which may be in your possession. The data which I authorize to be released consists of private data as defined by Minnesota Statute 13.02, Subd. 12, and has been collected by you as a result of my contacts and associations with you and/or your representatives. The information for which release is authorized includes all data which has been collected, created, received, retained, or disseminated in whatever form which in any way relates to my dealings with you or your agency. I understand that the purpose of permitting the City of Arden Hills to have access to this information is to detemtine my suitability for solicitation within the City. I further understand that this infomlation may subsequently be utilized for other purposes relating to solicjtation within the City. By signing this authorization, I hereby release the Bureau of Criminal Apprehension from any and all liability which otherwise mayor does accrue as a result of the release of any and all data, regardless of its accuracy. I also release the City of Arden Hills from any and all liability for its receipt and use of data received pursuant to this consent. This authorization shall be valid for a period of one year, but I reserve the right to, at any time prior to that expiration, cancel the v.rritten authorization by providing Mitten notice to the City of Arden Hills or to you of that fact. I have read Section 340 - Peddlers, Solicitors and Transient Merchants - of the Municipal Code. (Term of license is 30 days from date of authorization. No more than one 30 day license can be granted per calendar year.) Applicant Signature Date Full Priuted Name Date of Birth Driver's License No. State of] ssue: Social Security Number: Subscribed and worn to be before this day of .20 --- , Notary Public *Photocopy of current driver's license must be attached to this form. *This form must be filled out by each individual soliciting within the City of Arden Hills.