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■ . ■ L <br />f <br />; ; <br />DATA PRIVACY ADVISORY <br />in accordance wHh M.S. 13.04, Subd. 2. "Rights of subjects of data", we wouid tike to inform you <br />that your request for a permit or tioense from the City of Orono or any of its departments may <br />require you to fiimish certain private or confktontiai information. <br />You are notified that; <br />1. The information you furnish wiN 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 pennit 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 requestod permM or license requires Council action to approve, some information <br />may become public. <br />6. You have certain rights under M S. 13.04 (see following page) to review private data on <br />yourself. <br />6. Your full name is required to process this application or permit. <br />P _____ <br />Address <br />Last <br />JYYVI fcj MfJ - OOlS' <br />State zip Phone <br />' 1 <br />Signature <br />M <br />f 'i <br />r .v> « •♦> <br />r (If <br />.ri <br />? i <br />%A ' <br />I ‘ <br />J • <br />f.-r" t <br />{ .