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10.As the person executing this application for this license. I acknowledge that an investigation will be <br />conducted for use in determining my qualifications. I hereby expressly authorize release of any and all <br />Informatiori which any organization, company or person may have, including Information of a <br />confidential or privileged nature. I hereby release the City and any organization, company or person <br />furnishing Information to the City, as expressly authorized above, from any liability for damage which <br />may result from furnishing the Information requested. <br />10. The information requested on this form will be used by the City of Orono in the issuance of your license <br />or processing of your renewal application. The information that you supply on this form will become <br />public information when received by the City of Orono. Under Minnesota law (M.S. 270.72), the City <br />may be required to provide the business tax identification number and social security number of each <br />applicant to the Minnesota Commissioner of Revenue. <br />ANY FALSIFICATION OF ANSWERS TO THE ABOVE QUESTIONS WILL RESULT IN DENIAL OF THE <br />APPLICATION. <br />fklo <br />(Title) <br />(notary stamp) <br />Subscribed and sworn to before me this <br />day of t . 200^. <br />UNOA S. VEE <br />notary pvauc • <br />Ill C0B«lW» W* <br />(Notafy Pubiic/City Clerk) <br />SEE ATTACHMENT FOR ADDITIONAL DOCUMENTS REQUIRED AS PART OF THIS APPLICATION. <br />CITY USE: Date Fee Paid: i^LfoS Amount: ^0 ^ <br />Date Council Approved:. <br />Receipt No.: <br />License No.: <br />i