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' - <br />JI <br />DATA PRIVACY ADVISORY <br />In accordance with M.S. 13.04, Subd. ?, "Rights of subjects of <br />data", we would like to inform you that your request for a permit or <br />license from the City of Orono or any of its departments may require <br />you to furnish certain private or confidential inforiration. <br />•You are notified that: <br />1. The information you furnish will be used to determine your <br />qualification for the permit or license requested. <br />2. You may refuse to supply data, but refusal may require that <br />the City deny the permit or license. <br />3. The information may be shared with other local, state or <br />federal agencies to the extent necessary to process the permit or <br />license. <br />4. If your requested permit or license requires Council action <br />to approve, some informatiojx may become public. <br />5. You have certain rights under M.S. 13.04 to review private <br />data on yourself. <br />6. Your full name is requ:^'red to process this application or <br />permit. <br />% • <br />First Middle Last <br />Address LX <br />city <br />lYUO <br />state Zip <br />Phone <br />X underst nd my rights as stated above. <br />_ _ _ _ _ _ _ _ <br />« <br />k <br />1