Laserfiche WebLink
I�E��'l16,�D <br /> . ' ;_",' , �_� ,:��,. ;- <br /> DATA PRIVACY ADVISORY __;.;;;; <br /> In accordance with Minnesota State Statute 13.04 Rights of Subjects of Data, Subd. 2, "Tennessen warning", we <br /> would like to inform you that your request for a permit or license from the City of Orono or any��i�d��rt��NO <br /> 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 permit or license <br /> requested. <br /> 2. You may refuse to supply data, but refusal may require that the City deny the permit or license. <br /> 3. The information may be shared with other local, state or federal agencies to the extent necessary <br /> to process the permit or license. <br /> 4. If your requested permit or license requires Council action to approve, some information may <br /> become public. <br /> 5. You have certain rights under Minnesota State Statute 13.04 (see following page) to review <br /> private data on yourseff. <br /> 6. Your full name is required to process this application or permit. <br /> 5�� �.1.� C1.�11t.t7�2G <br /> First Middle Last �� <br /> �IL7 �u� c:�:a.ur� �, 5�.�- Io I <br /> Address <br /> �►�,,,,�.�'rr�.�yCA ►K�t� 55 3�3 �I�-��-J� <br /> City State Zip Phone <br /> I understand my rights as stated above. <br /> �� !�A��/�v� <br /> Signature <br /> Packet Last Updated: January 2015 <br /> Page 7 <br />