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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 /> � �ct�1�t��R cvc��rc� <br /> First M <br /> 1 h��0 LD�C�'Gf�c�G �L Ul� iddle Last <br /> Address <br /> �v uG-� �A��� �I N 5�3�� y�3�b01�' <br /> City State Zip� Phone ' <br /> I understa.d my rig ts a st,ted above. � <br /> � � <br /> � � <br /> Signature �� � , <br /> � � � � <br /> . � "�� �..�..<,�,k <br /> r�'F-•;�;.�r7;F j.• , <br /> F �!�'1� <br /> r` f.t'L.�.;�.+. .�:._._ �`� �,�, i <br /> ff. �'� �� 1'? ����� .:� <br /> ("� ( 't ' -• t'A?•;r'(•i� � <br /> 2i r•�"at: ��+', �'�� ' y '�'` ,.. �'Flp ' �, <br /> �+,'7.',g'^��/ ��:•�� .-'!•��� ' •. i.:`;l .i:�`1 <br /> � ;��))7 4_: . , ... .' , ._ p � ,�5� <br /> .. r��a.:i7;J'T'7 �:(':r` '� -..-�!� �'7%�` �`4::.Y_�' � � ' <br /> ¢j' l:.t•1 !' � 1�-�"�'�:.�._�/' �u.0 <br /> l:t ���r <br /> 1 <br />