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: � <br /> , . � . <br /> � <br /> , , <br /> I <br /> � <br /> � <br /> � <br /> � <br /> DATA PRIVACY ADVISORY <br /> i <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 Oro��o or any of its departments may <br /> require you to furnish certain private or confidential information. <br /> , , <br /> You are notified that: ; <br /> ; <br /> 1. The information you furnish will be used to determine your qualification for the permit or <br /> license requested. ' ;I <br /> � <br /> • 2. You may refuse to supply data, but refusal may require that the City deny the permit or <br /> license. 1 � <br /> 1 <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. 1 <br /> � <br /> 4. If your requested permit or license requires Council action to approve, some information <br /> may become public. �� <br /> � <br /> 5. You have.certain rights under M.S. 13.04 (see following page) to review private dafa on <br /> yourself. . ; <br /> � <br /> � . . . <br /> 6. Your fu►1 name is required to process this applicatio� or permit. <br /> . . ..._...;_.�e.�c�,... .: . ....._._. .. . <br /> � . �P�co�..._ . . . .. <br /> First Middle Last <br /> ��'� �c.o�-an �-. �� � <br /> Address� �� ;� <br /> F' �., ia i 5533� ``�Z. 1�-�1�• "�12-\ <br /> City . State ! Zip Phone <br /> ,,� <br /> I understand my rights as stated above. <br /> � . . . <br /> Signature . <br /> � <br /> , <br /> � . <br /> •<..^k.' ,.;,i ,.ay.:..;,t �,e'... � �. . <br /> " C' k � I <br /> � �' i ti ..,,....��''{{�; <br /> . ;y 4� y� .�� ry�;^y . <br /> �" +� i ��� �.� ' <br /> .�t � � I <br /> f <br /> , �:p',. �:`4�� ��; Ia14u � . - . <br /> � <br />