Laserfiche WebLink
<br />NOTIFICATION FOR LICENSE INVOLVING PRIVATE <br />, OR'CONFIDENTIAL INFORMATION <br />(Includes ,Tennessen Wa~g) <br /> <br />. . . . <br /> <br />In connection with your request for a licens~, the City has asked that <br />you provide information about yourself which is classified ,as private, <br />confidential, nonpublic, or protected nonpublic under the Minnesota <br />GovemmentData Practices Act. This means that this data is, not <br />ordinarily avallable to the generalpublie. Accordingly, the City is <br />required to inform you of the 'following: <br /> <br />1. The pmpose and intended use ~fthe ii1formatiQn~ested is to determine if you <br />are eIigJ.ole for a license from the City of Centerville. ' <br /> <br />2. You are not legally obligated to supply the requested information. <br /> <br />3. The known coJllltlqUeIlce of supplying the requested information is that the <br />information of further investigation could disclose information which could <br />cause your application to be denied. <br /> <br />4. The known consequence of refusing to supply the requested information is that <br />your request for a license cannot be processed. <br /> <br />5. A criminal charge, arrest, or conviction will not necessarily bar you from <br />obtaining a license with the City, unless the conviction is related to the matter <br />for which the license is sought, according to Minnesota Statute 364.03. <br />, However, fidlure to revea1the requested criminal information will be considered <br />falsification of the application and may be used as grounds for the denial of the <br />application. <br /> <br />6. Other governmental agencies necessary to process your application are <br />authorized by law to receive the information provided. <br /> <br />7. The City is required by law to furnish some of the information to the . <br />Deparbnent of Labor and Industry and the Minnesota Commissioner of <br />Revenue. " <br /> <br />8. During the application process, your name and address may be released to the <br />public. If the license is granted, all the data supplied will be available for <br />inspection by the public. <br /> <br />The undersigned, by signing this notice, acknowledges that he/she has read and <br />understood the contents of this notice and has received a copy of this notice. <br /> <br />f1-/J~ <br />SigDamre . <br /> <br />CJ c::r J- if '0 <{ <br />Date <br />