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s <br /> I <br /> ;cV0 .41 <br /> CITYof0R0N° <br /> ORONO <br /> .!, . . _ p5.• Municipal Offices <br /> . Post Office Box 66 <br /> Crystal Bay,Minnesota 55323-0066 <br /> kESII01% <br /> DATA PRIVACY ADVISORY <br /> cts <br /> to <br /> In accordance with M.S. 13.04, Subd• e"Rights <br /> froms thee CityrotatOrono oranylikeoff itsinform you that your request for a permit or license <br /> 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 <br /> permit or license requested. <br /> ?. You may refuse to supply data. but refusal may require that the City deny the <br /> permit or license. <br /> 3. The information may be shared with other local, state or federal agencies to the <br /> extent necessary to process the permit or license. <br /> 4. If your requested permit or license requires Council action to approve, some <br /> information may become public. <br /> 5. You have certain rights under M.S. 13.04 (see following page) to review private <br /> data on yourself. <br /> 6. Your full name is required to process this application or permit. <br /> PLEASE PRET <br /> <� 2 . T-,-/( <br /> �/t ��o <br /> First Middle Last <br /> . / oX o? l <br /> Address <br /> hy <br /> City State Zip Phone <br /> I understand my rights as stared above. <br /> ,47 <br /> Slat:.re Pr- <br /> TELEPHONE-473-7357• FAX-473-0510 <br />