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DATA PRIVACY ADVISORY <br />i- .Ip accordance with M.S. 13.04, Subd. 2. "Rights of subjects of data", we would like to Inform you <br />tf at your reguest for a permit or license from the City of Orono or any of its departments may <br />pjquire you to fUmish 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 permit or <br />license requested. <br />2. You may refuse to supply data, but refusal may require that the City deny the permit or <br />'' license. <br />3. The information may be shared with other local, state or federal agencies to the extent <br />necessary to process the permit or license. <br />4. If your requested permit or license requires Council action to approve, some information <br />may become public. <br />5. You have certain rights under M.S. 13.04 (see following page) to review private data on <br />yourself. <br />■ ‘ 1';.r <br />■•■A <br />6. Your full name is required to process this application or permit. <br />0 (/ h i"h. t V_________if___________^ ^ <br />Fifit Middle . <br />A/2.0 /tv <br />Last <br />Ackfress . <br />city 'St^ <br />A/4* / /y t-Y . f <br />Phone <br />r O <br />-V}. V.:..’ <br />■ » <br />I !■ I |T>I I ^tin.