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DATA PRIVACY ADVIS4RY <br /> In accordance with M.S. 13.0�, Subd. 2, "Rights of subjects of data", we would like <br /> to inform you that your request for a permit or license from the City of Orono or any of its <br /> departments 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 <br /> the permit or license requested. <br /> 2. You may refuse to supply data, but refusal may require that the City deny <br /> the permit or license. <br /> 3. The information may be shared with other local, state or federal agencies to <br /> the extent necessary to process the permit or license. <br /> 4. If your requested permit or license requires Counci( action to approve, some <br /> . information may become public. <br /> 5. You have certain rights under M.S. 13.04 (see following page) to review <br /> private data on yourself. <br /> 6. Your full name is required to process this application or permit. <br /> f��2-- S�� ����-��yc-r- <br /> First Middle Last <br /> 2��Z (�✓�/� N �,�.o c�v_ <br /> Address <br /> /�1 �Nn'�-�Nl�e�- Mn/ S�s3 os ��Z 2�6 �s�s- <br /> City State Zip Phone <br /> I understan as sta� above. <br /> Signature <br /> 8 <br /> ,�,'r� �' j,.�r:: ;., F.-;.�<" <br /> E�„�.t•(;�c; (;; Y;?,i `` r s� �,,. .. �:�;: c���,� <br /> � � r��I =: "t ���' Y �. {;:.ri <br /> ._�,�,- .. , <<� <br /> .'s5' f:.i � ��! �;.a <br /> , .. [cn�_...... f:i; <br /> ..�..� L•:_::+'.F.E:i::-1. <br />