Personal History Statement

PERSONAL HISTORY STATEMENT. When a government entity collects private or confidential data from an individual about that individual, the entity is required under Minnesota State Statue §13.04 subdivision 2 to post a Tennessen warning notice. The purpose of the notice is to enable an individual to make an informed decision about whether to give data about themselves to the government entity. Under Minnesota Statute §13.41 subdivision 2 name and the current designated contact address provided are public data and available upon request. All other information provided on your application prior to licensure approval is classified by law as private data and is accessible to you, but not to the public. Upon license approval, all information provided on your application, except for date of birth, social security number, prior addresses or data classified under Minnesota statute §13.02 subdivision12 as private or subdivision13 as protected nonpublic, is public data. Public data is available to any person upon written request to AGE. The data requested on each application will be used in determining whether you meet the statutory qualifications and requirements for the license you have applied. Data from your application will also be relied upon for contact and communication purposes by AGE. Chapter 340A and Chapter 299L of Minnesota Statutes require that applications for alcohol and gambling device licensure be completed on a form prescribed by the Commissioner of Minnesota Department of Public Safety and certain minimum information may be required. Individuals are strongly encouraged to review Chapter 340A for alcohol license requirements and Chapter 299L for gambling device license requirements. Failure to provide any of the requested information could result in the delay or possible denial of your license. All data collected and stored may be shared upon court order or with other government entities as authorized by law. www.FormsWorkflow.com