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....,,. . ���:. a ' . - . �_,; � <br /> ���� �,� -,s-�.:.,.. �- — � �,� � ���: a-.�: �,,, ���,�. <br /> y� . h� i� �.�.�_... <br /> �"=: , :; �f <br /> i. � � <br /> �' � <br /> `� ,�ATA PRiI►ACY ADVISORY <br /> E �in a�rdanc.e uvith Mlnnesata State St�tute 13.04 Rights of Sub)ects of Data, Subd. 2, 'Tennessen ro�raming",we <br /> �� ��'°� ,r�" w�ould fike to tr�arm you that yaWr r�u�t for a�rmlt or Ncense from the Ciq+of Orono ar any of�#s departmer�ts <br /> �1;� �� �t� may r�uire you to fumish�in private ar c.tmfld�tial information. <br /> ' � You are notifl�that: <br /> � �,�, <br /> ���� 1. The ir�forma�on yo� fumi�h wqi !�uaed to dstermine yaur qualiflcation for tpte permlt or li�r� <br /> �:���� r��ted. <br /> �� <br /> 2. You may refuse ta supply da�, but re�sai may require that the City deny thQ�rmif or lic�nse. <br /> 3. The lnforma�on may�shared with other loc�l.state ar federal ag�nctes#a the�xterit ry <br /> to proc�ess the�rrn�or license. <br /> 4. If your r�uested �mit or I��s� requlr� Cauru�l ad�n tcr approve, svrrte Irffc�cm�rtton m�y <br /> �me puMlc. <br /> 5. Yau have c�rtain rights under AAinneso#2►Stat�St�ute'13.04(s�fo!lc��+aing�ag�}to teview private <br /> data on�roursetf. <br /> 6. Your fiuti nam�is r�u{red to pr�s this appiicatlon or�rmit. <br /> �'���( �T�v�s L✓t��y <br /> First Middl� La <br /> It2�7 A��'��le�f /�e. �" ' <br /> Aaara�s <br /> r 5vi �.� ,,�1 5's337 g5Z ?36 3.�g� <br /> City , State Zip Phone � <br /> i understand my rights as stated abave. <br /> W ~ <br /> S�na <br /> ` .. <br /> . <br /> Psaket Leat U�ta�ted.• Ar�2018 <br /> �� <br />