Laserfiche WebLink
. . <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 15 .165, "Rights of subjects of data" , <br /> we would like tn inform you that your request for a permit or <br /> license from the City of Orono or any of its departments may <br /> require you to furnish certain private or confidential inform- <br /> ation. <br /> You are notified that : <br /> 1 . The information you furnish will be used to determine <br /> your qualification for the permit or license requested . <br /> 2 . You may refuse to supply data, but refusal may require <br /> that the City deny the permit or license . <br /> 3 . The information may be shared with other local , state <br /> or federal agencies to the extent necessary to process <br /> the permit or license. <br /> 4 . If yo�r requested permit or license req�ires Council <br /> action to approve, some information may becom� public. <br /> S . You have certian rights under M.S . 15 . 165 to review <br /> private data on yourself . <br /> 6 . Your full. name, and date of birth are required to process <br /> this application or permit. <br /> . ����G �� L ��(y�� <br /> First Middle Last <br /> 3��� � y��� <br /> ��y z�T� , �1N ��3�'i <br /> � 7/ �01� <br /> Phone <br /> I understand my ri hts as stated above . <br /> X <br /> Signature <br />