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r. <br />ex A *7, <br />DATA PRIVACY ADVISORY <br />In accordance \wlth M.S. 13.04, Subd. 2, "Rights of sut^cts of data", we would like to Inform you <br />that your request for a permit or license from the City of Orono or any of Its departments may <br />requite 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 permit or <br />license requested. <br />2. You may refuse to supply data, but refusal may require ttiat the City deny the permit or <br />license. <br />3. The infomnation may be shared with ottier 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 />6. Your full name is required to process this application or permit. <br />A/us <br />First Middle Last <br />Address _____/P/A/ <br />City State <br />SS2‘^I <br />Phone <br />I understanrliny. rights as stated *boy^ <br />Signature <br />i <br />ii * %: 1r i •••■. i>. I 1 S ^•I ft L % e:» <br />--