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�. � .�. .�� � 'v � •�..• . ...r �. ... � �• � . .�. . . � . �r . r .�.��...�e. � �r.w.�� r r r�.. r�..�. .. �. ��� �� `� r. ...�L <br /> DATA PRIVA�Y ADVISORY <br /> . <br /> (n accord c�with M.S. 13.04, Subd. 2, "Rights of subjects of data",wa would like to infarm you <br /> that your r quest for a permit or iicense from the City af Orona or�ny af its departments may <br /> require yo to furnish c��tsin private or confidential information. � <br /> ' . You are n ified that: . <br /> 1, Th infatmation you furni6h will b� used to determine your qualification for the permit or <br /> iic se requested. • <br /> • 2, Yo may refuse to supply data, but refusal may require that the City deny the permit;or <br /> lic se. � . <br /> 3, Th information may be shared with other lacal� state or federal agencies to the extent <br /> ne ssary to proaess the permit or license. � , . . <br /> 4. {f ur requested permit or Ilcense rsquires Council action,to approve,some information <br /> . m become public. � � � <br /> 5. Yo have certaln rlghts under M.S, 13.04(see foAowing page)to review prlvate data on <br /> • yo rself. . . <br /> 6. Ya r ful) name is required to process this application or permit, • <br /> � . <br /> � First � Middle Last � <br /> w <br /> Add ss � � • • • <br /> - a <br /> Cify . 5fate Zip . Phone. . <br /> � 1 unders d my rlghts$s stated above. <br /> . � <br /> Sign re . � <br /> . _ �, ,,� <br /> �`�"` „` ,;� J� .i4r� !', °�°` � <br /> ,� � <br /> � �' �'•; �j ::, r t> `;3 t <br /> . ' . [s�✓}t ,,s�;!3 . ,d.' ' .��:'� F',^:• ;c_�. y :;:.tl' ��y� � <br /> . [:i`,"( � � ��:'?} {I r �?I : �•% �.� �1 '% <br /> , . � [�J �� 4 ti.�.i ti.a i.,�rl ��`'�',`'�,__. ..j La �4•.L`y ,� . . <br /> (f �:r—r.;.;,,' <br />