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‘^1 <br />i <br />V <br />t. <br />DATA PRIVACY ADVISORY <br />In accordance with M.S. 13.04, Subd. 2, “Rights of subjects of data", we would like <br />to Inform you that your request for a permit or license from the City of Orono or any of its <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 <br />^ the permit or license requested. <br />2.You may refuse to supply data, but refusal may require that the City deny <br />the permit or license. <br />3. The information may be shared with other local, state or federal agencies to <br />the extent necessary to process the permit or license. <br />4. If your requested permit or license requires Council action to approve, <br />some information may become public. <br />5.You have certain rights under M.S. 13.04 (see following page) to review <br />private data on yourself. <br />6.Your full name is required to process this application or permit. <br />First Middle <br />9115 fW <br />Last <br />Address <br />City State Zip Phone <br />-i <br />i <br />tdaiu