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CITY OF RAMSEY <br />TENNESSEN WARNING <br />The City of Ramsey has asked that you provide information about yourself which may be classified as <br />private, confidential, nonpublic, or protected nonpublic under the Minnesota Government Data Practices <br />Act. This means that this data is not ordinarily available to the general public. Accordingly, the City is <br />required to inform you of the following: <br />1. The purpose and intended use of the information requested is to determine if you are eligible for a <br />license from the City of Ramsey. <br />2. You are not legally obligated to supply the requested information. <br />3. The known consequences of supplying the requested information is that the information or further <br />investigation could disclose information which could cause your application to be denied. <br />4. The known consequences of refusing to supply the requested information is that your request for <br />a license cannot be processed and/or a civil penalty may be imposed per city code section 10-119. <br />5. A criminal charge, arrest, or conviction will not necessarily bar you from obtaining a license with <br />the City, unless the conviction is related to the matter for which the license is sought, according to <br />Minnesota Statute 364.03, or subject to such other exceptions as are provided by law. However, <br />failure to reveal the requested criminal information will be considered falsification of the <br />application and may be used as grounds for the denial of the application. <br />6. Other governmental agencies necessary to process your application are authorized by law to <br />receive the information provided. <br />7. The City may be required to furnish some of this information to the Minnesota Department of <br />Revenue or other governmental agencies. <br />The undersigned, by signing this notice, acknowledges that he/she has read and understood the <br />contents of this notice. <br />Date Signature <br />�• 4 <br />Print Name <br />Email: planning cr cityoframsey.com <br />Rev 1/25 <br />