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x e <br /> �' � - • <br /> CITYof ORONO <br /> 1':, 1 'I�•- - ,�+ Municipal Offices <br /> Post Office Box 66 <br /> crystal Bay,Minnesota 55323-0066 <br /> `1kEsgog- <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to <br /> inform you that your request for a permit or license from the City of Orono or any of its <br /> departments may require you to furnish certain private or confidential information. <br /> You are notified that: <br /> ll be used to determine our qualification for the <br /> 1. The information you furnish wi <br /> permit or license requested. <br /> ?. You may refuse to supply data, but refusal may require that the City deny the <br /> permit or license. <br /> 3. The information may be shared with other local, state or federal agencies to the <br /> extent necessary to process the permit or license. <br /> 4. If your requested permit or license requires Council action to approve, some <br /> information may become public. <br /> 5. You have cerain rights under M.S. 13.04 (see following page) to review private <br /> data on yourself. <br /> 6. Your full name is required to process this application or permit. <br /> PLEASE PRLN- T <br /> c E� a��=�t.. <br /> T Last <br /> First iviiddle <br /> /1,30 <br /> ,address <br /> Ciry <br /> State Zip Phone <br /> I understand my rights as stated above. <br /> Signature <br /> TELEPHONE-473-7357• FAX-413-0510 <br />