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DATA PRIVACY ADVISORY <br /> In accordance with Minnesota State Statute 13.04 Rights of Subjects of Data, Subd. 2, 'Tennessen waming", we <br /> wouid like to Inform you that your request for a permlt or license from the City of Orono or any of its departments <br /> may requfre you to furnish certairt pr�vate or oon�idential irtformation. <br /> You are notified t#�at: <br /> 1. The informatfon you iurrtish wEll be used to determine your qualification for the permit or license <br /> requested. <br /> 2. You msy refuse to supply data, but refusai may require that the City deny#he permit or license. <br /> 3. The ir�formation may be shared with other bcal, state or federa! agencies to the extent necessary <br /> to process the permit or license. <br /> 4. ff your requested permlt ar license requires Cfluncil action to approve, some information may <br /> become public. <br /> 5. You have certain rights under Minnesota State Statute 13.04 (see fallowing page) to review <br /> private data on yourself. <br /> 6. Your full name is required to process this application or permit. <br /> � e �'' 10 <br /> . <br /> First Middle Last <br /> 13 Fs� ��� �.�' ���-�- <br /> Address <br /> ���� � �v ��3� 1 � �Z z i � -00�3 <br /> City State Zip Phone <br /> I understarcd my rights as stated above. <br /> ,' <br /> Signa <br /> I��CEtVED <br /> Packet Lest IJpdeted.• Jarruary 20fb �U� �2 2Q��J <br /> Page f3 � <br /> C�Y OF 4RONb <br />