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DATA PRIVACY ADVISORY <br />In accordance with M.S. 15.165, "Rights of subjects of data", <br />we would like to inform you that your request for a permit or <br />licens.: from the City of Orono or any of its departments may <br />require you to furnish certain private or confidential inform- <br />ation. <br />You are notified that: <br />1. Th- information you furnish will be used to determine <br />your qualification for the permit or license requested. <br />2. Yals may refuse to supply data, but refusal may require <br />that the City deny the per:.pit or license. <br />3. The information may be share.3 with other local, state <br />or federal agencies to the extent necessary to process <br />the permit or license. <br />4. If your requested permit or license requ:res council <br />a,:tion to approve, sonic information may become public. <br />5. You have certian rights under M.S. 15.'16') to review <br />private data on yourself. <br />6. Y3ur full name, and date of birth are requ.red to process <br />this application or permit. <br />First MiBle Last <br />AdTi I s <br />I undorstand my rif-411t!; as stated above. <br />x <br />Iiilnatures <br />