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CITY OF MOUNDS VIEW <br /> COUNTY OF RAMSEY <br /> STATE OF MINNESOTA <br /> RELEASE OF INFORMATION <br /> The date disclosed by the applicant is collected by the City of Mounds View for the <br /> purpose of: <br /> PROCESSING OF A PEDDLERS, SOLICITORS, <br /> AND TRANSIENT MERCHANT LICENSE <br /> You are not required by law to disclose any of the data. However, if you do not <br /> disclose the information requested, it may prohibit you from being issued a license to <br /> operate in the City of Mounds View. This data, other than the name and address of <br /> the subject, is classified as private data on individuals pursuant to Minnesota State <br /> Statute 13.41, Subdivision 2. It can be released only at the valid request of a law <br /> enforcement agency, pursuant to Minnesota State Staute 13.81, Subdivision 2, or to <br /> any agency or individual specifically authorized by State or Federal Statute to have <br /> access to the data or specifically authorized by the Minnesota Commissoner of <br /> Administration pursuant to Minnesota State Statute 13.05, Subdivision 4(c). Any other <br /> disclosure will be made only by reason of a judicial order or with the informed <br /> consent of the subject of the data. <br /> I, c y1/_- 3 A,) r./'/ 4 A; i_h <br /> (number and street) (city) (county) (state) (zip) <br /> born 7"/ , am the person named in the attached <br /> application for peddler, solicitor, transient merchant in the City of Mounds View. <br /> Jam/ L / . <br /> S`'' moi; 7/ -ee / <br /> DATE /SI/GNATURE <br />