Laserfiche WebLink
CITY CLERK'S OFFICE <br />REQUEST FOR BACKGROUND CHECK INFORMATION <br />CITY OF RAMSEY \,ck0. koW <br />City of <br />r,_ <br />RAMSEY. <br />DATA PRIVACY ADVISORY: The data supplied on this form will be used to assess the qualifications for a license. This data is not legally required but the City <br />will not be able to grant the license without it. If a license is granted, the data will constitute a public record. The data is needed to distinguish this application from <br />others, to identify this application in City license files, to verify the identity of the applicant, to contact the applicant if additional information is required and to <br />determine if the applicant meets all ordinance requirements. <br />INFORMATION TO BE USED FOR BUSINESS LICENSE PROCESSING ONLY <br />Ramsey Police Department Records Division <br />Individual Background Check to Include: Criminal History, Drivers License Check, Outstanding Warrants <br />Please Print <br />Type of License Applied For: 'O ! it 6 ' 1, b v— <br />Business Name: e 4+ 6 lit ,S /1 6 5'' C. . 0.4--e C <br />•Business Address: 55 a Cc W e s 4-- f7G v` J cA. V' iak_Vl f o- 6 ,c- <br />Fv-td 1 t v MN 65 1-1.3 `Z <br />Applicant Information: <br />Driver's license, State ID, or Military ID Number (attach copy): kilq :5 ! <br />Name: A ay 6L-A- C v` e. G-" Date of Birth: g " 19— ` I9 +3 <br />First Middle Last <br />Phone(daytime): 6S l - iq F <br />Address: <br />Sex: 14 Race: /.` U 1 <br />M 1-t4ef <br />5 e ticLAs y P c ,c5 F� � f-eV 55y,3 <br />State Zip Code <br />Street <br />Other Names Used (in past 5 years): // A <br />Other Addresses (in past 5 years): <br />(Attach separate sheet if necessary) <br />City <br />U (A ` <br />�-IS <br />I, the undersigned do hereby authorize the RAMSEY POLICE DEPARTMENT to disclose all criminal history record <br />information to the City Clerk's Office f r the purjose of licening with the City of Ramsey. This authorization shall be <br />valid for year fro .• = date of signa <br />Signature <br />)gq <br />Checks: <br />Comments: <br />Application Processed by: <br />.Lee a , c7C)(� <br />. Datee <br />FOR OFFICE USE ONLY <br />Approved ❑ Denied Ii <br />Driver's License 0 Warrants ❑ <br />l C e utc. ti_1r <br />.AAA Date: I / 3 l <br />Our Mission: To work together to responsibly grow our community, and to provide quality, cost-effective, and efficient government services <br />