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i �, � <br /> � (�.. <br /> / ' <br /> ' <br /> 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 that your request for a permit or license from 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 ceitain 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 /> �oher� �o �i s-��� <br /> First � Middle Last <br /> _��� �0.�/ZC�� �'�)CY. W. <br /> Address <br /> , u,� a � ��5� �175�i7�J <br /> City State Zip Phone <br /> I unde t nd my right as st ted above. <br /> r <br /> Signature <br /> 10 <br /> 6�ECENED <br /> D E C 1�-7 2008 <br /> � ClTY OF ORONO <br />