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DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you <br /> that your request for a permit or license from the City of Orono or any of its departments may <br /> . 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 <br /> license requested. <br /> 2. You may refuse to supply data, but refusal may require that the City deny the permit or <br /> license. � <br /> 3. The information may be shared with other local, state or federal agencies�to the extent <br /> necessary to process the permit or license. <br /> 4. If your requested permit or license requires Council action to approve, some information <br /> may become public. <br /> 5. You have certain rights under M.S. 13.04 (see following page)to review private data on <br /> yourself. <br /> 6. Your full name is required to process this application or permit. <br /> . .�—�----- <br /> �i►Mo-�y vi R�i�. �e��.YS�oh <br /> First Middle Last <br /> + ��"�'� �''J �...�hG�1 �-V� • . <br /> AddrLQ Ke vi I 1� , /�l N • �5v'�-{' ��52�$98�54�la'�' <br /> City State Zip Phone <br /> I understan�d_my rights as stated abr,o.v�e. ' , <br /> /-�:,�-�.. 1/• I -�-�--y-�.-, <br /> Signature <br /> k ��f. `i.�e A : <br /> � F ` �3i °'� � }� • ' <br /> ��.�. .,'�r� �•�} Y�� .✓'� ylb; <br /> � �y,.� *y`J'j,f'rt'� F •ti{i`��'',1� �•'�`J 5' . <br /> � �t�' �' ,+• <br /> �� i�;. �; ,{�:rs, r' r`� <br /> .�.•�'� ��S�U,:�jf" �+ •�-'W�+�' 1 <br />