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DATA PRIVA�Y ADVISpRY <br /> �n accordance with M.S. �t3.a4, Subd. 2, "Rights af subjecfs bf data",we wotald like <br /> to inform you that your request fiar a permi�or license fram the City of Qrono or any of its <br /> departments may require you to fumish certain private or canfiden#ial information. <br /> You are notified that: <br /> 1. The informatian you furnish will be used to determine your qualification for <br /> #he permi#or license rec{uested. <br /> 2. You may refiase to supply data, but refusal may require fhat the Cify deny <br /> the permit ar license. <br /> 3. ' The information may be shared with other locai,state ar federa!agencies ta <br /> the extent necessary to proce�s the permit or license. <br /> 4. If your rec{uested permit ar license requires Cae�ncil action fo approve,some <br /> in€ormation may become pubiie. <br /> a. You have certain rights under M.S. 13.U� (see fallowing �age) to review <br /> prnrate data on yourself. <br /> �. Your full name is required to process this applica�on or permit. - <br /> Brad M. .lones <br /> �irst M�ddle Last <br /> 1245 Woodhill Ave - <br /> Add ress <br /> Wayzatta MN 55391 952-,476-Q899 <br /> City State Zip Phon� <br /> I understarid my righ s a st ed bave. <br /> b 2..o p�"j <br /> vignatur <br /> �'Y' �.,� <br /> � <br /> *� !`'�':1: <�� �1 <br /> �� ��, ��,� �f;1 �;�;; �.f� �' <br /> �: ��;� <br /> 6 r� ��;'� .:,� r, 4 i� �� <br /> F. y-�r. E','/ <br /> �C"?. ��4� r : J:� r>� <br /> _�„�'°',�``a�,�'✓� cu:'��;.'::�a -=w`-�•-'�'1/ tr���g�Ctii�� <br />