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11110121, 1:51 PM <br />Name of Dog <br />Breed <br />Description <br />Revize Online Forms <br />MV License # <br />Rabies Expiration <br />M M/D D/YYYY <br />Upload Proof of Current Rabies Vaccinations (if records on file with the City are expired) <br />Choose File No file chosen <br />ALL APPLICANTS: <br />* Have you ever had a license revoked? If yes, please explain. <br />No <br />Will an outside kennel be constructed to house the dogs? If yes, a zoning permit is required. <br />Not a kennel. But a fence will be on part of the outdoor property. <br />Zoning Permit Application CLICK HERE <br />Format: MM/DD/YYYY <br />The data on this form will be used to approve your license. Some requested data is private. Private data is available to you and the City or <br />State staff who need this information to perform their duties, but is not available to the public. <br />You are being asked to answer questions and provide information pursuant to the application process that is required by Minnesota State <br />Statute and the City of Mounds View. The information you provide is government data in accordance with Chapter 13 of State law known as <br />the "Minnesota Government Data Practices Act". You are not required by law or ordinance to answer questions or provide the information <br />requested. A refusal to answer questions or provide information being requested will prevent the City of Mounds View from processing the <br />application for which you are applying. <br />The information you provide may be classified as "public", "private" or "confidential" pursuant to the "Government Data Practices <br />Act". Access to this information can be obtained by persons who are deemed eligible pursuant to the "act". This access can include the <br />subject(s) of the license application, anyone they give their informed consent to consistent with Minnesota State law, or by court order. <br />My signature constitutes agreement of the Tennessen Warning and application. <br />* Applicant Signature <br />Paul Holt <br />TO PAY CLICK HERE <br />Date <br />11 /10/2021 <br />Format: MM/DD/YYYY <br />https://moundsviewmn.rja.revize.com/reports/179343 2/2 <br />