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. <br /> o. . o . . <br /> ,j'' � ` . <br /> .� � � <br /> - o `_ � <br /> --- , �+��� O� � <br /> '1 .�_ ,9y �iunicipalO�iices <br /> ,�,e�. ,+'� .« �� , - fy Post Office Sox 66 � <br /> ��'� '�°���� _. �'�' Crysral Bay,tiiinnewta 5a`32'i-OOG6 <br /> . „' •� <br /> � ��� 1 . � '� <br /> , 9j���, <br /> DATA PRIVACY A.D'VLSORY <br /> In accordance with ��f.S. 13.0�, Subd. ?. "Riahts of subjects oT data". we would like to <br /> inform you that your request for a p�rmit or license from the Ciry of O:ono or any of its <br /> departments may require �lou to furnish cercain 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 licensz requested. <br /> ?, You may refuse to suppl}� �aca, but refusal may require that the City der.y the <br /> �ermit or �icense. <br /> 3, The i.*iformation may be shared with uther local, state or federal a�encies to the <br /> extent necessary t� p:�c�ss «�z permit or license. <br /> :�. If your requested permit or license requires Council action to approve. same <br /> inf'ormation may becam� puolic. <br /> �. You ha��e cer.ain ri�hts under M.S. 13.Q4 (se� follo�i�inQ p3Qe) to review grivate <br /> data on yourself. <br /> 6, Your full name is required to process this application or permit. <br /> PLEASE PRIl\rI' <br /> � <br /> c9DD � �� � . <br /> First �1idd:e �t <br /> ! 3 � � � S�. <br /> Address <br /> �� �� ( _ �7��S 7.5� <br /> (���IJ� State Zip Phone <br /> Ciry <br /> I understand my ri�hts as staced above. <br /> �v . <br /> ignature <br /> ��o*rE-a�r3-r3s�• Fax-a�-osio <br />