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DATA PRIVACY ADVISORY r/ <br />In accot <ance with M S 13 .04, Subd. 2, “Rights of subjects of data’-f please be informed <br />that your request for a variance from the City of Orono may require you to furnish certain <br />private or confidential information. Please be infom..*u of the foUowing; <br />1.The information you provide vrill be used to determine your qualification for <br />the variance requested. <br />2. You may refuse to provide data, but refusal may require the City to deny the <br />variance. <br />3.The information may be shared with other governmental agencies, if necessary, to <br />process your application. <br />4. Any City Council action taken will become a matter of public record <br />5. Your legal name is required to process this application: <br />First Name Middle Name Last Name <br />Address <br />City State Zip Code <br />1 understand my rights as stated above <br />Signature <br />Variance Application Form <br />Pag€-^ I j <br />j