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Af the person executing this application for this license, I acknowledge that an investigation will be <br />conducted for use in detennining my qualifications. I hereby expressly authorize release of any and all <br />Intennatlon which any organization, company or person may have, including Information of a <br />confidential or prlvlie^ nature. I hereby release the City and any organization, company or person <br />furnishing infbnnatlon to the City, as expressly authorized above, from any liability for damage which <br />may result from furnishing the information requested. <br />) 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 />MV P^l RIFirATION OF ANSWERS TO THE ABOVE QUESTIONS WILL RESULT IN DENIAL OF THE <br />PPLICATION. <br />Signature)(Title) <br />Subscribed and sworn to before me this <br />notary stamp)day of .. 20. <br />(Notary Public/City Clerk) <br />BS^BI <br />SEE ATTACHMENT FOR ADDITIONAL DOCUMENTS REQUIRED AS PART OF THIS APPLICATION, <br />CITY USE; Date Pee Paid: Amount: * / QO . C C' <br />Date Council Approved;__________ <br />Receipt No.: <br />License No.: