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.�; . <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 /> 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 /> fhe permit or license. <br /> 3. The information may be shared with other local, state orfederal agencies to <br /> the extent necessary to process the permit or license. . � <br /> 4. If your requested permit or license requires Council action to approve, <br /> some 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 /> �,�'�'/1 ���'v��'` CJ, T'��a�� <br /> First Middle Last <br /> Y <br /> ��°�� �'���i�� �����° <br /> Address � <br /> � � ��,�� <br /> a�-`�+r�.�c7 ��/� .S",� .,� .a,t'' �,�'�- �'�6'-T L►�,��=� <br /> .a <br /> C�fY State Zip Phone <br /> I understand my ri hts as stated above. <br /> � <br /> � Signature � � . . . <br /> 7 . � .. ��s . ��� <br /> ��` ������ �4''� f�� ,� .� <br /> . b�Cu�c�!F',y�7.: ..� � �y r,.�(."••'"� <br /> � r,;v,, ��, �{. <br /> �*�1� � ,j:�' �r a�,��- � <br /> .�Jw �.. f�l�1Lj�'�� P! � <br /> H <br />