Laserfiche WebLink
DATA PRIVACY ADVISORY <br /> In acoordance with Minnesota State Statute 13.U4 Rights af Subjects of Data, Subcf. 2, 'Tennessen waming", we <br /> would like to infiorm you that your request for a permit or license irom the City of Orono w any of Its departments <br /> may require you 3n fumish certain private or canfidential ir�format�On. <br /> You are notfied that; <br /> 1. The iMormation you fumish wili be used to determine your qualiflcation for the permit or license <br /> requested. <br /> 2_ You may refuse to supply data, but refusa!may require that the City deny the permit w license. <br /> 3. The irrFormation may be shared with ather local, state or federal agendes to the exterrt necessary <br /> to process the permit or license. <br /> 4. If your requeated permit or licanse requlres Coundl actlon to approve, some inform�tior� may <br /> become public. <br /> 5. You have certain rights urxier Minnesota State Statute 13.04 (see following page) to review <br /> private data on yourself. <br /> 6. Your full name is required to process this appllcatfon or perm�. <br /> �/l G�iR eL �fi'�7`br7 LQ'�'OY� <br /> L i s a �a.r�'� L a.•�o.� <br /> Firs# Middle Last <br /> �F�2�t �'p� GlQ.ss �r' , <br /> Address <br /> �slc.a /'�l�l ��31� �/a-z7o- 9'��3 <br /> Cfty State Zip Phone <br /> I understand my ri�hts as stated abave. <br /> �_ _ <br /> Signature <br /> RECEIVED <br /> Peckef tast Updeted.- Januery 2078 f1 <br /> Page 13 AUU � � Z u�5 <br /> � 3 7 �� c�N o�oRONo <br />