Laserfiche WebLink
DATA PRIVACY ADVISORY <br /> In accordance with Minnesota State Statute 13.04 Rights of Subjects of Data, Subd. 2, "Tennessen waming", we <br /> would like to inform you that your request for a permit or license from the City of Orono or any of its departments <br /> may require you to fumish certain private or confidential information. <br /> You are notified that: <br /> 1. The information you fumish will be used to determine your qualifica6on for the permit or license <br /> requested. <br /> 2. You may refuse to supply data, but refusal may require that the City deny the pertnit or license. <br /> 3. The information may be shared with other local, state or federal agencies to the extent necessary <br /> to process the permit or license. <br /> 4. If your requested permit or license requires Council action to approve, some informa6on may <br /> become public. <br /> 5. You have certain rights under Minnesota State Statute 13.04(see following page)to review private <br /> data on yourseff. <br /> 6. Your full name is required to process this application or permit. <br /> � �� ���� <br /> First Middl Last <br /> l�� 1ti.�i!l Vv►�irL �e �� <br /> Address <br /> � <br /> ��r�n� UV��k ��wl 32�• 2�5� lc��� <br /> City State Zip Phone <br /> I understand rights as stated ov . <br /> Signatur <br /> Packet Last Updated: August 2015 <br /> Page 7 <br />