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r., -- -- -------- - -- -- <br /> , i <br /> ',.f <br /> f .. <br /> j . <br /> ��� DATA PRIVACY ADVISORY <br /> In accordance with Minnesota�State Statute 13.04 Rights of Subjects of Data, Subd. 2, "Tennessen <br /> warning", we would like to inform you that your request for a permit or license from the City of Orono or <br /> any of its departments may require you to furnish certain private or confidential information. - <br /> . You are notified that: ' . <br /> " 1. � The information you furnish will be used to determine your qualification for the permit or <br /> license requested. . � � <br /> 2. You may refuse to supply data, but refusa� may require that the City deny the permit or <br /> license. <br /> 3. The information may be shared with other local, state or federal agencies to the extent <br /> necessary to process the permit or license. <br /> 4. If your requested permit or license requires Council action to approve, som� information <br /> � may become public. <br /> 5. You have certain rights under Minnesota State Statute 13.04 (see following page) to <br /> � review private data on yourself. <br /> 6. Your fuil nam�is required to process this application or permit. <br /> � <br /> ST��EW 1� Se,Nw��`1' � � s � <br /> First Middle Last � <br /> , 1R.�:.�.�: �� �� C� rD �. , <br /> Address � <br /> M: �, ,���o�. � �,,,,r� s'�'3 y 3 . 9�� -3 ys- -o s'y.� <br /> City State Zip Phone <br /> � I understand my rights a ove. <br /> Signature � <br /> Packet Last Updafed• 04/19/2093 . <br /> Page 20 of 23 • <br />