11-28-2016 Council Packet - Laserfiche WebLink

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9. Applicant and his associates in this application will strictly comply with all the laws of the Stage of Minnesota governing the taxation and the safe of intoxicating liquor, wine, or 3.2 percent malt liquor or beer and the Orono City Code, and I hereby certify that I have read the foregoing questions and that the answers to said questions are true of my own knowledge. 10. As the person executing this application for this license, I acknowledge that an investigation will be conducted for use in determining my qualifications. I hereby expressly authorize release of any and all Information which any organization, company or person may have, Including Information of a confidential or privileged nature. I hereby release the City and any organization, company or person furnishing information to the City, as expressly authorized above, from any liability for damage which may result from furnishing the information requested. 11. In accordance with M.S. 13.04, the information requested on this form will be used by the City of Orono in the issuance of your license or processing of your renewal application. Per Chapter 30 of the Orono Minnesota City Code, a computerized criminal history inquiry and/or a driver's license history inquiry on the applicant may be conducted to verify the information provided with the application. The information that you supply on this form will become public information when received by the City of Orono. Under Minnesota law (M.S. 270.72), the City may be required to provide the business tax identification number and social security number of each applicant to the Minnesota Commissioner of revenue. Any falsification of answers to the above questions w111 result in denial of the application. of Applicant V :ry aft 0 6u l.i ir„hi n} Print Name Review by Administration. ❑ Approved ❑ Denied ❑ NA Review by Police De artment: ❑ Approved Denied ❑ NA Commerce: Title /a Date For Office Use Only By: Page 6