Laserfiche WebLink
DATA PRIVACY BDVISORY <br /> In accordance with Minnesota State Statufe 13.04 Rights of Subjects of Data, Subd. 2, "Tennessen warning", we <br /> would like to inform you that your request for a permit or license from the City of Orono or any of its departments <br /> may require you to fumish certain private or conf�dential ir�formation. <br /> You are notified that: <br /> 9. T'he 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 Clty deny the permit or Iicense. <br /> 3. The information may be shared with other local, state or federal 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. You have certa9n rights under Minnesota State Statute 13.Q4(see following page)to review private <br /> data on yourself. <br /> 6. Your ftrli name is required to process this application or permlt. <br /> � � <br /> First Middle Last <br /> �lz� 5���� � <br /> Address <br /> e�bi�s �� 5���2�- .s�4� <br /> City State Zip hane <br /> I understand my ri ts a tated above. <br /> r <br /> l <br /> Si ature <br /> I�EC�iVED <br /> SER 21 Z016 <br /> Varianoe�ca8on—Mey 2096 �} <br /> Page 10 -� � � � � .��'+'�'(��QNQ <br />