Laserfiche WebLink
DATA PRIVACY ADVISQRY <br /> In accordance with Minnesota State Statute 13.�4 Rights of Subjects of Data, Subd. 2, "Tennessen waming", we <br /> woufd tike to iriform you that yaur request for a pertnit or license from the City of Orona a any of its departmerrts <br /> may require you to fumish certain private or coMidential ir�formation. <br /> You are notfied that: <br /> 1. The information you furnish 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 infoRnation 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 pemnit or license requires Council action to approve, some ir�farmation may <br /> become public. <br /> 5. You have certain rights under Minnesota State Statute 13.04 (see f�fowing page} to review <br /> private data on yoursefF. <br /> 6. Your futl name is required to process this application or�it. <br /> �e �a��� �a�r <br /> First Middle Last <br /> 31� N� Stt�R-� O(�-�vE <br /> Address <br /> �r� M� SS�tI �52 -2Sb-$082 <br /> Cit�r State Zip Phone <br /> I understand my rights as stated above. <br /> Signatur <br /> Packet Last Updated.� January 2015 <br /> Page 7 <br />