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<br />MAR-25-Cl MeN 1:57 PM <br /> <br />frv oa ~nREST "L'KE <br />v.. _.I. l v. '. 1\ <br /> <br />FAX NO, ri51 464 4868 <br /> <br />p 5 <br /> <br />"' <br /> <br />I HEREBY CERTlPY THAT I HAVE AEAD TI:lB FOROOJNG QUESTIONS AND TriA r 'THE <br />ANSWERS TO SAID QUESTIONS ARB TRUll OF MY OWN KNOWLElXiIl, I FURTHER <br />UNDERSTAND THAT AN INVESTIGATION, FE!! NOT TO EXCE.ED $50.00, MAY B:E CHARGED <br />TO AN APPLIC^,". BY THE CITY, IF CONVICTED OF ANY ClUMl! OTHEA THAN A TRAFFIC <br />OFFENSE, I WILL REPORT SlJCH CONVICTION TO TIUJ CITY 01' FOMST LAKE <br />lMMBDlATEL y, <br /> <br />SlGNATliRE OF APPLICANT A.."ID DATE SIGNED <br /> <br />I HEREBY AUTHORIZE TIUJ FOREST LA.Ka POueE DEPT. TO CHl'lCK MY POLICE RECORD <br />AND DO HEREBY RELEASE niB CITY OF FOREST LAKE AND ALL INDIVIDUALS <br />CONNECTED THERBWl7H FROM At,.L LlABJI.JTY FOR DAMAGE WHA TSOIlVER INCtJR.iUID <br />IN FlJRNISHll..C sueH Rl!POllT. <br /> <br />SIGNA Th"RE OF APPLICANT <br /> <br />R.ENEWAL FEE [R S!O.OO PER C"-LRNDAR YEAR <br /> <br />"--- <br />