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September 1,2016 and after <br /> ATTACHMENT B <br /> Acknowledgment of Restrictions on Use and Disclosure of Confidential Financial <br /> Information <br /> I, Donna Cobillas , am currently employed as [a][an] <br /> Budget& Revenue Officer with [the [femn)[City][Vi°llagejof City of Decatur, Illinois (the <br /> ["Municipality"] "])][ ]. I am authorized under the Reciprocal <br /> Agreement on Exchange of Information between [name of Municipality][ and the <br /> Illinois Department of Revenue to request,view, or receive confidential financial information on behalf <br /> of the [Municipality][C-sly]. I have received and reviewed the Reciprocal Agreement on the Exchange <br /> of Information and I understand its terms. <br /> By my signature below I acknowledge that the unauthorized use or disclosure of confidential <br /> financial information obtained under the Reciprocal Agreement is prohibited by law. I further <br /> acknowledge that any person who divulges confidential financial information in any manner, except <br /> pursuant to a court order or as otherwise authorized by law, is guilty of a Class B misdemeanor and <br /> subject to a fine of up to $7,500 per disclosure. I understand that disclosing confidential financial <br /> information to persons who are not explicitly authorized under the Reciprocal Agreement constitutes <br /> unauthorized use and disclosure. <br /> Employer: (Please print) Donna C o b i l l a s <br /> Position/Title: (Please print) Budget & Revenue Officer <br /> [Signature] = <br /> [Date] <br /> 0 iv 1 <br /> Reciprocal Agreement on Exchange of Information—Sales Tax 5 <br /> (R-9/16) <br />