Wisconsin Administrative Code
Department of Administration [Gaming]
Chapter Game 5 - Licensure
Section Game 5.09 - Personal information and authorization for release

Universal Citation: WI Admin Code ยง Game 5.09

Current through August 26, 2024

In an application for a license under s. 562.05(1) (a) or (b), Stats., the applicant shall include the following with respect to each individual required to be identified in the application form, or otherwise required to be identified in the application form, or otherwise required to be identified by this chapter or s. 562.05(5), Stats., as an applicant, partner, director, officer, or owner, directly or indirectly, of 5% of any equity security or other ownership interest in the applicant and such other individuals as shall be required by the division:

(1) Full name, business and residence addresses and telephone numbers, all previous residential addresses for the preceding 20 years or if less than 20 years at the current residence address, date of birth, place of birth, and 2 references.

(2) An authorization for release of personal information, in the form prescribed by the division, signed by the individual and providing that such individual:

(a) Authorizes a review by and full disclosure to any agent of the division or Wisconsin department of justice, division of criminal investigation of all records concerning the individual, relating to the information provided in the application form, whether the records are public, non-public, private or confidential.

(b) Recognizes the information reviewed or disclosed may be used by the state of Wisconsin, its employees, the division staff and agents of the division, to determine the signer's qualifications for a license under s. 562.05(1) (a) or (b), Stats.

(c) Releases authorized providers and users of the information from any liability under state or federal data privacy laws.

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