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ttj ''*'■* • »fe"?L ■ ?r^v.. % "1wS#*J 1 - <br />.f^''tsfibi 71 <br />m0li^:' <br />*''r <br />s- <br />ir* <br />DATA PRIVACY ADVISORY <br />Rights of subjects ofV? <br />* In accordance with M.S. 13«04r Subd. 2r <br />data”* wa would like to inform you that your request for a permit or <br />: <br />• ''I ‘'Jwit : <br />■'.: <br />-You are notified that: <br />isf; ■ ■' <br />.;u' <br />f,.;' ■ ■ <br />‘s>>t <br />ii; <br />}•■# ■■■ <br />fc. <br />yy'^v <br />r-y <br />IK <br />1. The information you furnish will be used^to determine your <br />2. You may refuse to supply data, but refusal may require that <br />the City deny the permit or license. <br />a^Vn°=r,r.^°\."‘^.xrenf <br />license. <br />-i <br />4. If your requested permit or license requires Council action <br />to approve, some information may become public. <br />'s <br />5. You have certain rights under M.S. 13.04 to review private <br />data on yourself. <br />j <br />6. Your full name is required to process this application or <br />permit. <br />First liddle <br />■=^f V=; <Lau^ P(3al> <br />*Atfaress <br />(Otz^o <br />>C <br />CiW State <br />A <br />Zip <br />fh <br /></7/^ -<y^ / <br />OTe <br />Ss I understand my rights as stated above.