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<br />, <br /> <br />. <br /> <br />MAR-26-01 MON 1 :57?M cry OF FOREST LAKE <br /> <br />FAX N~ 651 464 4858 <br /> <br />I HEREBY CERTIFY THAT! HAVE lUlAD THE FORGOING QL'llST10NS AND T'rlA T THE <br />ANSWERS TO SAID QL1!STIONS ARB TRlJE OF MY OWN KNOWLEOOIl. I FURTEER <br />UNDERSTAND THA r AN INVESTIGATION, FEE NOT TO EXCEllD $50.00, MAYBE CHARGED <br />TO AN APPL1CA.".J;lY THE CITY. IF CONVICTED OF ANY CRlME OTHER THAN A TRAFFIC <br />OfFENSE, r WILL R.EPO&T stiCH C0N\I1CTION 10 THE CIn OJ! /!OUST LAKE <br />1MM!DIATELY, <br /> <br />SIGNA Th"'RE OF APPLICANT AND DATE SIGNED <br /> <br />I HEREBY AUTHOllIZl! THE FOUST LAK!! POUCE DEPT. TO CllllCK MY pOLICE RECORD <br />AND DO HEREBY RELEASE THE cm OF FORBSTLAXE AND ALL INDIVIDUALS <br />CONNECTED THBIU!WlT'li FROM ALL LlABlUTY FOR DAMAOIl WHA rsoEVER INClJR.iUlD <br />IN FURNISHL"lC SUCH REPORT, <br /> <br />SIGNATURE OF APPLICANT <br /> <br />RENEWAL FEE IS SSO.OO PER ~A LENDAR YEAR. <br /> <br />l __________ <br />.-- -- --- <br /> <br />F. 5 <br />