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i <br /> . E . <br /> � <br /> n <br /> i <br /> t , <br /> i , <br /> ,S <br /> DATA PRIVACY ADVISORY , <br /> ° In accordance with M.S. 13.04, 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 /> , <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 /> ; <br /> � 2. You rnay refuse to supply data, but refusal may require that the City deny <br /> � the permit or license. � <br /> � ; <br /> s 3. The information may be shared with other local, state orfederal agencies to � <br /> � the extent necessary to process the permit or license. � <br /> i <br /> � 4. If your requested permit or license requires Council action to approve, <br /> , some information may become public, <br /> 3 <br /> � <br /> � 5. You have certain rights under M.S. 13.04 (see following page) �o review <br /> ; private data on yourself. <br /> ; 6. Your full name is required to process this application or permit. <br /> .i <br /> �� i,`, �, r., P�.�,,-l-� ��� <br /> ` First IVliddle Last � <br /> � <br /> � 1 25 2C) C,J e�.. 2c�..�c,.. � ��� . '' <br /> ', � ; <br /> i Address <br /> . <br /> � (.''l �.A��.�k.�; �t� . S S 3 �S z�-� 9� ^ � 3 � o <br /> : ..._ ....,._.. <br /> � City State Zip Phone <br /> ; <br /> � <br /> � <br /> ; I understand rights as stated abov� � <br /> � �.-�-��1 n-�`�-e.,�..�--� , ' <br /> ,Signar re <br /> , � <br /> 7 . _ -�=== . . ' <br /> �:;' :i �.,:. . ' . . . . . <br /> � -JC"��i:., . . <br /> '. F.IV�C�ti:n.... �. , • �,�, , <br /> 6 �"t.:1�"'�:" " � . . �'.. <br /> �; r> �`� � . , .. . . �..... _.._.:a� ; <br /> ., <br />