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i'v ‘--#fe.•psk <br />t <br />m- <br />Iv <br />■> ^ <br />1 s <br />DATA PRIVACY ADVISORY <br />Rights of subjects of <br />• ' .U' <br />Vj'V* , <br />f;.’ <br />■K': <br />mW- <br />|y;- <br />■ <br />.-1-1 'f-. <br />m <br />.•<>You are notified that: <br />1 The information you furnish will be used to determine youi <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 information 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 required to process this application or <br />permit. <br />7>) ' <br />First <br />1 O G <br />cr>nrvjj^ <br />Middle Last <br />Address <br />c\ <br />n7T7rh[T^------------ <br />------------------ f <br />V>~v^ <br />State <br />,rr3 ^ i <br />Zip <br />n cs'ni <br />Phone <br />» .4