Laserfiche WebLink
DATA PRIVACY ADVISORY <br /> !n accordance with Minnesota State Statute 13.04 Rights of Subjects of Data, Subd. 2, 'Tennessen warning", we <br /> would like to infQrm you that your request for a permit or licensc from the City of Orono ar sny of its departments <br /> may require you to fumish certain private or confidential information. <br /> You are not'�'ied that: <br /> 1. The information you fumish will be used to determine your qualification for the permit or license <br /> requested. <br /> 2. You may refuse to supply data, but refusal may require that the City deny the permit or license. <br /> 3. The information may be shared with ather local, state or federaf agencies to the extent necessary <br /> to process the permit or license. <br /> 4. If your requested permit or license requires Council action to approve, some information may <br /> become public. <br /> 5. Yau have certain rights under Minnesofa State Statute 13.04{see following page}to review private <br /> data on you�sel#. <br /> 6. Your full name is required to process this application or permit. <br /> �� ����Vc� <br /> First Middle Last <br /> y�-I o �CdwY. �c� S <br /> Address <br /> Oc� Mti 5539 � <br /> City State Zip Phone <br /> I undersfand my rights as tated above. <br /> .- <br /> Signature <br /> �ECEf�E�j <br /> v�te�a�r�ra.►-M8Y2o�s SEP 21 2Q1fi <br /> Page 10 � � � �' <br /> ,� C(TY OF ORONO <br />