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.,. . i <br />~ ... · f..f ~-6' <br />CITY of ORONO <br />Mwticipal Offices <br />Post Office Box 66 <br />Crystal Bay, Minnesota 55323--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. The information you furnish will be used to determine your qualification for the <br />permit or license requested. <br />2 . You may refuse to supply data , but refusal may require that the City deny the <br />permit or license . <br />3 . The information may be shared with other local , state or federal agencies to the <br />extent necessary to process the permit or license. <br />4. If your requested permit or license requires Council action to approve , some <br />information may become public. <br />5. You have certain rights under M.S. 13.04 (see following page) to review private <br />data on yourself. <br />6. Your full name is required to process this application or permit. <br />First Middle <br />2 t/oo <br />Address <br />City State Zip Phone <br />I understand my rights as stated above. <br />Signature <br />TELEPHONE-483-7357 • FAX-473-0510