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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, Gregg D.Zientara , am currently employed as [a][an] <br /> City Treasurer&Dir of Finance with [the [44m4q;4[City][Villa-gel[geo of City of Decatur, Illinois (the <br /> ["Municipality"][" " )][ ]. I am authorized under the Reciprocal <br /> Agreement on Exchange of Information between [name of Municipality][ire-eey] and the <br /> Illinois Department of Revenue to request, view, or receive confidential financial information on behalf <br /> of the [Municipality][]. 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) Gregg D . Z i e n t a r a <br /> Position/Title: (Please print) City T r e a u r e r & Director of Finance <br /> w :r �. :. <br /> [�ignature] <br /> [Date] <br /> Reciprocal Agreement on Exchange of Information—Sales Tax 5 <br /> (R-9/16) <br />