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CITY Or GEM LAKE Heritage Hall 4200 Otter Lake Road I.Gern Lake, MN 55110 551-747-27g0192 651-747-2795 (fax). E-mail cit a gemlakemn.or r Background Check Authorization 0nIess.otherwise. indicated, the data in this application may be used: to approve your license. or permit: Upon approval of the license or permit, the. information contained in this application shall be deemed pul lic.unless classified as private by slate law.. Private data is available to you: and the City.or State who.need this information to perform their duties, but is not available to the public: You are not legally required to provide this data, but the City may not be able to approve:your license or permit if you do not provide it. 13y signing below, you are acknowledging having reviewed Gem Lake:Ordinance. No. 1.45, as it relates to the .retaiI sale of.edible can nabinoid products; and have familiarized yourself with its provisions. Minnesota Statute,. section 279C;.5ubd. 4 requires all licensing authorities to require appl icants. to provide their social security number or individual taxpayer identification number and Minnesota business identification number, as applicable, and to provide that information to the Minnesota Department of Revenue upon. request. Under the Minnesota Government Data Practices Act andIhe Federal Privacy Act of 1974,:lhe City.is-re quired to advise. you of the following regarding the use the information requested herein, 1. This information may be.used to deny the issuance or renewal of your license in the. event you Owe Minnesota sales tax, employer's with hglding in motor veh i c I e 'exc i se taxes; I Upon receiving this information, the Iicensing.authority will supply it only to: the Minnesota Department of Revenue. However, under. the Federal l xchange of Information Agreement, the Department of Revenue. may: supply this information to the Internal Revenue. Service;. and I Failure to supply this information may jeopardize of delay processing of your license or renewal. I .declare.that the information l have provided on this application is truthful and i tin derstand that falsification of answemor failure to provide. -the required data may result in denial of the.application. I authorixe..the City:of Gem bake to investigate and:make whatever inquiries necessary to verify accuracy of the. information provided. By signing below; I agree to this background check authorization and authorizes .the White Bear Lake Police Department to request a copy of your consumer credit. report for purpose of conducting a license background investigation. AtOch additional license verification forms for each owner. Applicant Signature; Social Security #: Attach copy of driver's license Driver's License. Number: Date of Birth: State: If applicant has no driver's license, attach copy of government issued. identifieation. Please note: Background checks may take. iap to 30 days to complete. Once completed,.the.license determination is scheduled for consideration by the City Council, which can take an additional two weeks based an the City Council meeting schedule. City Council meetings are scheduled at 7 p,m. an the third Tuesday'of every month: