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I ' <br />CITY of ORONO <br />Municipal Offices <br />Street Address: <br />2750 Kelley Parkway <br />Orono, MN 55356 <br />DATA PRIVACY ADVISORY <br />. Mailing Address: <br />P.O. Box 66 <br />Crystal Bay, MN 55323-0066 <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 re:ft,ise to supply data, but refusal may require that the City deny the permit <br />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 data <br />on yourself. <br />6. Your full name is required to process this application or permit. <br />Ronald D. Lauer <br />First Middle Last <br />48l: <br />Address <br />E. bBk:e Sereee <br />Wa y zata MN 55391 952-475-3330 <br />City State Zip Phone <br />Sr _ .. ~..:.:..r .. \ <br />• • I -~• <br />/--=~ .• <br />. :;• h;J <br />,-./j,(.P <br />~~ <br />Telephone (612) 249-4600 • Fax (612) 249-4616 9