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<br />MASSAGE LICENSE APPLICATION
<br />CITY OF MINNETONKA
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<br />INFORMATION ADVISORY ANI} AUTHORIZA TION:i,:
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<br />.. .:. . FOR RELEASEOF 1i\IFORMA TION ,..r
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<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.
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<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.
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<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.
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<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.
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<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.
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<br />Signature of Applicant
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<br />Date
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