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10/9/25, 10:43 AM Revize Online Forms t Has OCM license or pre-approval been granted? Upload OCM License or Pre-approval (if applicable) © Yes Choose File No file chosen ❑ No Once your registration application has been accepted by the City of Mounds View, the following requirements must be met. Additional items may be required. • Applicable fee as established in the city's fee schedule. Initial registration fees and renewal registration fees are nonrefundable; • Proof of taxes, assessments, utility charges or other financial claims of the city or the state are current; • A copy of a valid state license or written notice of OCM license preapproval; • The business/property must pass a preliminary compliance check conducting by the City of Mounds View to ensure compliance with Chapter 121 and any other regulations established pursuant to M.S. § 342.13. The requirements listed above are preliminary and may be supplemented or revised during the permit application process. PRIVACY NOTICE: I understand the information provided in this application may be considered private or confidential data. I further understand that I may not be required by law to provide such information. The purpose of providing such information is to aid the City in its determination on said application. I acknowledge that providing, or failing to provide, such information may affect the City's determination on said application. I understand this information will be made available to the City of Mounds View, its City Council, agents and representatives, as well as the Minnesota Department of Revenue, the Internal Revenue Service, or any other person or entity authorized by law to receive said information. I release the City of Mounds View from any and all liability for its receipt and use of data received pursuant to this application. r Applicant Signature " Date Peter Schmidt 10/09/2025 Format: MM/DD/YYYY If you have questions, please email infoCo�moundsviewmn.org https://moundsviewmn.ria.revize.com/reports/987301 3/3