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Pursuant to Minnesota Statute 270.72 Tax Clearance; Issuance of Licenses, the licensing authority is required to provide to <br />the Minnesota Commissioner of Revenue your Minnesota business tax identification number and the Social Security Number <br />of each license applicant. <br />Under the Minnesota Government Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of <br />the following regarding the use of this information: <br />1. This information may be used to deny the issuance, renewal, or transfer of your license in the event you owe the <br />Minnesota Department of Revenue delinquent taxes, penalties, or interest. <br />2. Upon receiving this information, the licensing authority will supply it only to the Minnesota Department of Revenue. <br />However, under the Federal Exchange of Information Agreement the Department of Revenue may supply this <br />information to the Internal Revenue Service. <br />3. Failure to supply this information may jeopardize or delay the processing of your licensing issuance or renewal <br />application. <br />Please supply the following information and return along with your application to the agency issuing the license. DO NOT <br />RETURN TO THE DEPARTMENT OF REVENUE. <br />License being applied for or renewed: Temporary Special Events Permit <br />Licensing Authority: City of Ramsey <br />(Name of City, County, or State Agency issuing License) <br />PERSONAL INFORMATION (if applicable): <br />Applicant's Name: <br />Applicant's Address: <br />Social Security Number: <br />BUSINESS INFORMATION (if applicable): <br />Business Name: <br />Business Address: <br />City <br />City <br />State ZIP <br />State ZIP <br />Minnesota Tax Identification No.: <br />Federal Tax Identification No.: <br />If a Minnesota Tax Identification number is not required, please explain on the reverse side. <br />Signature <br />Position (Officer, Partner, etc.) Date <br />