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l~ <br />\. •' i <br />I <br />CITY of ORONO <br />Municipal Offices <br />Post Office Box 66 <br />CrystalBa~Minnesob55323-0066 <br />DATA PRIVACY ADVISORY <br />In accordance with M .S . 13 .04, Subd . 2 , "Rights of subjects of data", we would like to <br />inform you that your request for a permit or license from the City of Orono or any of its <br />departments may require you to furnish certain private or confidential information. <br />You are notified that: <br />1. <br />., <br />3. <br />4. <br />5 . <br />The information you furnish will be used to determine your qualification for the <br />permit or license requested. <br />You may refuse to supply data, but refusal may require that the City deny the permit <br />or license. <br />The information may be shared with other local , state or federal agencies to the extent <br />necessary to process the permit or license . <br />If your requested permit or license requrres Council action to -approve, some <br />information may become public. <br />You have certain rights under M.S. 13.04 (see following page) to review private data <br />on yourself. <br />6. Your full name is required to process this application or permit. <br />C.1:::0--, ~ Le_e_ w ~dd 0...VL j <br />Middle Last <br />Address <br />City State Zip Phone <br />TELEPHONE -4n}7357 • FAX -473--0510