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CITY OF RAMSEY <br />TENNESSEN WARNING <br />In connection with your request for a License, the City of Ramsey has asked that you provide information about <br />yourself which is classified as either private or confidential by the Minnesota Government Data Practices Act <br />(M.S.A. 13.04). Accordingly, the City is required to inform you of the following: <br />1. The private or confidential information requested includes, but may not necessarily be limited to, the <br />following: Your social security number or Minnesota business identification number. <br />2. The purpose and intended use of the information requested is: To comply with Minnesota Statutes, <br />Section 270.72. <br />3. You are required to supply the requested information. <br />4. The known consequences of supplying the requested information are as follows: Loss or denial of the <br />requested license if you owe the State of Minnesota delinquent taxes, penalties or interest. <br />S. The known consequences of refusing to supply the requested information is: Your request for a license <br />cannot be processed. <br />6. The following persons and entities are authorized by law to receive the information if provided: State <br />of Minnesota - Department of Revenue and other government agencies as provided by law. <br />The undersigned, by signing this notice, acknowledges that he/she has read and understood the contents <br />of this notice. <br />Date' <br />I l <br />\> LI f/U'-'- i ,e," -i <br />Signature, f Applicant f <br />ii 6r"t ii\1r,r <br />Print Name <br />d.� <br />k`7_f� <br />Our Mission: To work together to responsibly grow our community, and to provide quality, cost-effective, and efficient government services <br />