Laserfiche WebLink
<br />.. <br />. ~ <br /> <br />'- - <br /> <br />~ <br />-t' <br /> <br />NOTD1CATION FOR LICENSE INVOLVING PRIVATE <br />OR CONFIDENTlAL INFORMATION <br />(lnclu~es Tennessen 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 classified as private, <br />confidential, nonpublic, or protected nonpublic under the Minnesota' <br />Government Data Practices Act. This means that this data is Dot <br />ordinarily avaUable to the general public. Accordingly, the CitY is <br />required to inform you of the following: . <br /> <br />1. The pmpose and intended use of the information requested is to determine ifyo'il <br />are eligible 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 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 />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, failure to reveal the requested criminal information will becoi1sidered <br />fillsification 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 fmnish some of the information to the <br />Department of Labor and Industry' - -li1id 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 thpt he/she has read and <br />understood the contents of this notice and has received a copy of this notice. <br /> <br /> <br />~A.p~ <br />Signature <br /> <br />'t9~ <br />Date <br /> <br />31 <br />; <br /> <br />I)~ <br />