Laserfiche WebLink
DATA PRIVACY AmiSORV <br />In accordance with M.S. 13.04, SuM. 2. "Rights of subjects of data", we would like to inform <br />you that your request .or a permit or license from the City of Orono or any of its departments may <br />require you to furnish certain private or confidential information. <br />You are notified that: <br />1. The information you furnish will be used to dctermme your qualification fos die permit <br />or 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 />vourself. <br />6. Your full name is required to process this application or permit. <br />riff <br />First <br />^32- <br />Middle Last <br />Address <br />Or£tl^} <br />City State <br />5~535 / Cfe. - <br />Zip Phone <br />I understand my rights as stated above. <br />J. <br />^gnature <br />,t ■ . <br />• ... * <br />us CJ