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r,.... <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2 , "Rights of subjects of <br /> data", we would like to inform you that your request for a permit or <br /> license from the City of Orono or any of its departments may require <br /> you to furnish certain private or confidential information. <br /> � --You are notified that: <br /> ��f- • <br /> 1. The information you furnish will be used to determine your <br /> qualification for the permit or license requested. <br /> 2. You may refuse to supply data, but refusal may require that <br /> the City deny the permit or license. <br /> 3. The information may be shared with other local , state or <br /> federal agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or license requires Council action <br /> r�.- to approve, some information may become public. <br /> 5. You have certain rights under M.S. 13.04 to review private <br /> data on yourself. <br /> 6. Your full name is required to process this application or <br /> permit. <br /> cR,�« � Z�N;�� <br /> First Middle Last <br /> �IS Sr� �� ,4�et�uE <br /> Address <br /> W/��(ZA1'� �N Ss3�1� <br /> City State Zip <br /> �?S-��o?3 <br /> Phone <br /> I n erst d y r' ts as stated above. <br /> lgn re <br /> :.� . <br />