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iit <br />DATA PRIVACY ADVISORY <br />i <br />\ f I <br />* - • -W • * <br />* •*.> m' <br />T„ .ccordance with H.S. 13.04, Subd. 2, "Rights of subjects of <br />data'^, we would lihe to inform you that your request for a permit or <br />Jou to furnish certain private or confidential information. <br />-You are notified that: <br />1. The information you furnish will be used to determine your <br />qualification for the permit or license requeste . <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 <br />federal agencies to the extent necessary to process the permit <br />license. <br />4, If your requested permit or license i^c^ires Council action <br />to approve, seme information may become public. <br />5. YOU have certain rights under H.S. 13.04 to review private <br />data on yourself. <br />6. Your full name is required to process this application or <br />----------E5st - <br />Address <br />ZiD <br />Phone <br />Z understand my right s statea above. <br />qna