Laserfiche WebLink
Tvpe, Dates and Locations of Intended .Business <br />/ I D Peddler (License Required) O Solicitor (Registration Only) Li Transient Merchant (License. Required) <br />O Annual License O Daily License <br />Start Date: End Date;. <br />Location where. business will be conducted: <br />Phone.Numl er while conduoting.business; <br />Baekgrouad •Cheek <br />ff Applying for a daily Iiceme,A tnWnnimiof R consecutive days is perinitted_ <br />Have -you ever been cotnvioted within•the•iast fiver(5) years ot'any, felony, gross .misdemeanor or.misdemeanor-for yiolatirig any state <br />or-WgraI. statute•or any local•ordinanee, other than. minor traffic offenses?.if yes, please describe. <br />0 yes. ❑ Igo <br />If yes,.please. descxjbe; <br />The Minnesota Data Practices Act requires that you be. advised of the following information: <br />As:an applicant for kPeddler.License, you are asked to provide private and/or confidential information about -`yourself that will be used <br />to check driving history, criminal history, arrest records, warrant information, and other relevant records.. Ybmmay refuge to proyide <br />this iinformation:.However,.should you refuse., our investigation cannot be completed and will result in your application not -being <br />processed. With the exception of your Social Security Number, the information you provide is public and will be used by the City of <br />White..Be.ar.Lake Police Department, the Gem. ake City Council, and/or the,.general public. This AUTHORIZATION FOR <br />RELEASE OF INFORMATION will expire two years from the date you sign IL <br />I have. read and. understand the above Data Praeticcs-Advisary: <br />Signature: <br />Date: <br />Cityof Gem Uke Peddlers, Solicitors and Transient hferchants License - Page 3 oF9 <br />