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<br />~ <br /> <br />.' <br /> <br />I HEREBY UNDERSTAND AND AGREE THAT: <br /> <br />1. INFORMATION REVEALED BY AN APPLICANT FOR AN OCCUPATIONAL LICENSE IN THE CITY OF MINNETONKA WI~ <br />USED BY THE CITY IN ACCORDANCE WITH FEDERAL AND STATE LAWS REGARDING PRIVACY OF CRIMINAL RECO'W <br /> <br />2. A CRIMINAL CONVICTION WILL NOT BAR AN APPLICANT FROM OBTAINING A LICENSE WITH THE CITY OF MINNETONKA <br />UNLESS SUCH CONVICTION IS DIRECTLY RELATED TO THE OCCUPATION FOR WHICH THE LICENSE IS SOUGHT, <br />ACCORDING TO MINNESOTA STATUTES li364.03. <br /> <br />3. HOWEVER, FAILURE TO REVEAL A CRIMINAL CONVICTION WILL BE CONSIDERED FALSIFICATION OF THE APPLICATION <br />AND MAY BE USED AS GROUNDS FOR DENIAL OF THE APPLICATION. <br /> <br />I DECLARE THAT THE INFORMATION I HAVE PROVIDED ON THIS APPLICATION IS TRUTHFUL, AND I AUTHORIZE THE CITY OF <br />MINNETONKA TO INVESTIGATE THE INFORMATION AND CONTACT THE PERSONS NAMED ON THE APPLICATION. <br /> <br />I HEREBY AGREE TO NOTIFY THE CITY OF ANY CHANGE IN THE INFORMATION PRESENTED HERE WHICH MAY OCCUR DURING <br />THE LICENSE PERIOD. <br /> <br />I HEREBY AUTHORIZE THE CITY OF MINNETONKA TO HAVE ACCESS TO ALL SOURCES OF INFORMATION WHICH MAY BE <br />CONSULTED TO VERIFY THE INFORMATION I HAVE PROVIDED ABOVE. THIS INCLUDES AUTHORIZATION TO CHECK CRIMINAL <br />HISTORY RECORDS IF I HAVE BEEN ASKED TO PROVlDE THAT INFORMATION. <br /> <br />x <br /> <br />(SigrtBtuRr of Applicant) <br /> <br />Subscribed and sworn to before me a Notary Public <br /> <br />. <br /> <br />on this <br /> <br />day of <br /> <br />,19 . <br /> <br />Commission expires on: <br /> <br />lNotary Public) <br /> <br />H:\'NP\FORMS\A~1-MASS,BUS <br /> <br />(4) <br /> <br />--_..~ <br />