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, , SUMNER HARRINGTON Fax:952-5�6-5566 Jan 12 2007 12:00 P.03 <br /> � DATA PRIVA�Y ADVISORY . <br /> In accord co with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to infarm you <br /> that your r quest for a permit or Iicense f�om the City of Orono or any af its departments may <br /> require yo to furnish certain private ar cot�fidential information. <br /> � You are n ified that; <br /> 1. Th information you furnish will be used to determ(ne your qualification for the permit or <br /> lic ss request�d. • <br /> � 2. Yo may refuse to supply data, but refusal may requ(re that the City deny the permit;or <br /> lic se, � <br /> 3,. Th information may be shared with other local, state or federel agencies ta the extent <br /> ne ssary to yxocess the permit or license. . <br /> 4. If ur requested permit or ficense requires Council action to appreve,some information <br /> m became public. <br /> 5. Yo have certaln rights under M.S, 13,04(see following page) to r�eview private data on <br /> • yo rsalf. . <br /> 6. Yo r fuU name is �equired to process this application o�permit. • <br /> � � - <br /> � First Middie Last <br /> c�t. <br /> Add ss ' � � <br /> - Z3 <br /> ��;y . State Zi� , Phone , <br /> • 1 unders d my ri�hts �s statad abov�. . . <br /> , � <br /> Sign re ' <br /> r^=.�, . <br /> ri.� i�' •- . ' .. .. " . <br /> � � ' � � - . . . ' . . <br /> 1 • ' . , <br />