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<br />MASSAGE LICENSE APPLICATION <br />CITY OF MINNETONKA <br /> <br /> <br />In connection with your application for a massage license, you are being requested to <br />provide data which may be classified as private, confidential, non-public or protected non- <br />public data under the Minnesota Data Practices Act. This means that this data is not ordinarily <br />available to the general public. <br /> <br />The purpose of the information requested in the application is to provide background <br />for the investigation of massage license applicants required by City ordinance. Providing the <br />information will assist the Police Department in preparing an investigative report for the City <br />Council's review. This information may be given to the City Council of Minnetonka and used <br />by the City Council in its deliberations when granting or denying the massage license. If the <br />information is provided to the City Council, it may become part of a public record, available <br />to any interested individual. <br /> <br />You have the right to refuse to supply the requested information. If you do so, this fact <br />may be reported to the City Council and may result in the denial of your massage license <br />application. <br /> <br />A criminal charge, arrest or conviction will not bar an applicant from obtaining a license <br />with the City of Minnetonka unless the conviction is directly related to the matter for which <br />the license is sought, according to Minnesota Statutes, Section 364.03. However, failure to <br />reveal the requested criminal information will be considered falsification of the application and <br />may be used as grounds for the denial of the application. <br /> <br />* * * * * <br /> <br />I acknowledge being informed and receiving a copy of the above advisory and agree to <br />provide the requested information. I further authorize the release to the City of Minnetonka <br />of any information about my business and financial affairs which may be requested from any <br />firm relative to my financial background. I also authorize the City of Minnetonka to investigate <br />the information on the application provided in my application and to contact the persons <br />named on the application. I understand that incorrect or incomplete information provided by <br />me in my application may be considered falsification of the application and may be used as <br />grounds for the denial of the application. <br /> <br />Signature of Applicant <br /> <br />Date <br /> <br />I <br />