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<br />. . <br /> <br />'< .' <br /> <br />",,' <br /> <br />. <br /> <br />NOlll1:CATION FOR LICENSE INVOLVING PRIVATE <br />OR CONFIDENTIAL INFORMATION <br />(Inclnd~ Te~essen Wa~g) <br /> <br />. . . . .' . <br /> <br />In, connection With your request for a license, the City has asked that <br />you provide'information about yourself which is ~Iassified as private, <br />confidential, nonpublic, or proteeted nonpublic under the Minnesota <br />Government Data Practices Act. This means that thiS data is not <br />,ordinarily available to the general public. Accordingly, t~e City ,is <br />required to inform you of the following: <br /> <br />1. The p1lq)OSe and intended use of the information requested is to determine if you <br />are eligible for a license from the City ofCenterville. <br /> <br />2. You are not legaJly obligated to supply the requested information. <br /> <br />3. The known consequence 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 />S. A criminal charge, mest, or conviction will not necessarily b8:r 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, failure to reveal the requested criminal information will be considered <br />fBlsification 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 /> <br />Itll /(/~. <br /> <br />~n~ <br />Signatme <br /> <br />Date <br />