Fillable Personal Information Form Short-Term Rental Hosting Platforms (City of Minneapolis)

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Personal Information Form Short-Term Rental Hosting Platforms (City of Minneapolis)

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The Personal Information Form Short-Term Rental Hosting Platforms (City of Minneapolis) form is 2 pages long and contains:

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Personal Information Form – Short-Term Rental Hosting Platforms
This form must be completed by each of the following with a copy of driver’s license or government issued
photo ID attached.
Applicant
Authorized Agent/Contact Person
Owners, Partners, Directors, Officers, and Shareholders who own 25% or more of corporate stock; or
the three members who own the highest percentage of interest in the company
I. Background Information
Legal Corporate Name of Business
Trade Name of Business (DBA)
Business Address
City
State
Zip Code
Your Name (First, Middle, Last)
Your Business Phone Number
Your Cell Phone Number
Residential Street Address
City
State
Zip Code
Social Security Number (SSN) or
Individual Tax Identification Number (ITIN)
Date of Birth
% of ownership
First, middle, or last names you have ever used or been known by:
II. License History
Have you held a City of Minneapolis Business License? Yes No If yes,
Type of License From To
Have you ever had a business license denied or revoked by Minneapolis or any other government entity?
Yes No If yes, explain.
Have you ever been convicted of any ordinance violation, petty misdemeanor, misdemeanor, gross
misdemeanor, or felony? This includes both civil and criminal offenses. This includes state, local, and federal
offenses. Do not include parking violations. Yes No If yes,
Offense Fine/Penalty City State Date
III. Data Privacy Advisory
The Minnesota Data Practices Act requires us to tell you the following information. As an applicant for a
Minneapolis business license, we ask for private and/or confidential information. We use this to check driving
history, criminal history, arrest records, warrant information, and other relevant records. You are not legally
required to provide this information. If you do not, we cannot complete our investigation or approve your
application. The information you provide is public and will be used by the Minneapolis Police Department,
License Inspection Unit, the Minneapolis Division of Licenses and Consumer Services, the Minneapolis City
Council, and the public. This Authorization for Release of Information will expire two years from the date you
signed it.
#1
IV. Verification
The City of Minneapolis uses the information on this application to determine qualifications for a license. You
are not legally required to provide this information. If you refuse, we cannot approve your application. After
we approve your license, all information is public (MN Statutes, Chapter 13).
A signature is required.
I have read and understand the above Data Privacy Advisory.
I have read and agree to the Terms and Conditions for electronic signatures, records and payment.
I, (print name) __________________________________________________, certify or declare under penalty
of perjury under the laws of the State of Minnesota that the information on this application, checklist, and
attached documents is true and correct. All information is subject to verification by the State of Minnesota. I
understand that false information may result in the denial, suspension or revocation of my business license.
By typing your name, you are electronically signing this application.
Signature of Applicant _____________________________ Title ________________________ Date ________
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Personal Information Form Short-Term Rental Hosting Platforms (City of Minneapolis)

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Completed 16 December 2021

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