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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 <br /> to inform you#hat your request for a permit or license frorn 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 Council 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 /> ���Z�c��-r� � I�����-�}�c-�s�s2 . <br /> First Middle Last <br /> ( 54n ��� �EF-r <br /> Address <br /> ��,��� ►M r� 553°c l �5z - �'�3 -� �-5�a <br /> City State Zip Phone <br /> I understand my rights as stated above. , <br /> � � � <br /> Signature <br /> 8 . <br /> ' k� , �,.��-- �,��-�,,. ��� �. ;� <br /> t� � •��, I <br /> crr - 1� t-. , : _c '"• �:� �� t , <br /> ��:��'� � ::- �' .�,. � . <br /> . �' L_r's'' �4.y,�.,� '� � �.:.`fry +,1..N�::.�,�....�, j�.���� '+ � � <br /> �.:�.��>• . <br />