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RAIAMASIYAMQ-PlY <br /> In accordance with Minnesota State Statute 13 04 Rights of Subjects of Data. Subd. 2, "Tennessen warn!ng". we <br /> would like to inform you that your request for a permit or license front the City of Creno or any of its departments <br /> may require you to furnish certain private or confidential information. <br /> You are notified that <br /> 1. The information you furnish will he used to determine your qualification fur the permit Or icense <br /> requested <br /> 2. You may refuse to supply data, but refusal may require that the City deny the permit or license <br /> 3. The information may be shared with other local, stale or federal agencies to the extent riocessai y <br /> to process the permit or license <br /> 4 If your requested permit or license requires Council action to approve, some information 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 yourself. <br /> Your full I larllt; is required to process this application or permit <br /> r.r• 7C4L0." <br /> kiddie 7Lri.Si <br /> IC72 I/0 S/4 CA/ 14100 d <br /> Address <br /> 33-33/ (//, -) 7/0- -?-0SL <br /> City State <br /> undersr ndy rights as slated ove <br /> /0/1-1/ <br /> attire <br /> Packet Updaled. 2V15 <br /> .4,tw <br /> _ _ <br />