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DATA PRIVACY ADVISORY <br />In accordance with M.S. 13.04, Subd . 2, "Rights of subjects of data", we would like to inform you <br />that your request for a permit or license from the City of Orono or any of its departments may <br />require you to furnish certain private or confidential information . <br />You are notified that: <br />1. The information you furnish will be used to determine your qualification for the permit or <br />license requested. <br />2 . You may refuse to supply data, but refusal may require that the City deny the permit or <br />license. <br />3 . The information may be shared with other local, state or federal agencies to the extent <br />necessary to process the permit or license. <br />4. If your requested permit or license requires Council action to approve, some information <br />may become public. <br />5 . You have certain rights under M.S. 13.04 (see following page) to review private data on <br />yourself. <br />6. <br />_Ad_d_es_so_~(o~M~--------r"----->-~---3_9_/ __ ~-✓~d-~-~-0)5 19 <br />City j / Zip Phone <br />I understand y rights <br />{/ <br />c;'t1 <br />) _} <br />e::. ~