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TY OF ORONO � 6124730510 09/24/96 14:00 �g7 :03/03 N�,522 <br /> - . <br /> Ssc.13.04 ItiGli'1'$UF SUBJ�C'tS OF DA'i'x <br /> Subd. 1. 'l�ps of dab. 2'Ae d�ba of indlvidua(ou v�hom the data I�-nored or to be smcni shall ba si set forth in tWa uc8on_ <br /> Subd,l. Inlormrtloa reqsdr.d to b��tne ladtvidmi. M lcdividud uked ro�uppiy priwa or oanfideati�daa eonosruing himaelf,�hall <br /> be Inlortaed of; (�)d�a pu�poce and inmaded uu of d�e requesceQ d�p wlthlu nc�collecdnQ ltue agenoy.polldcal aubdlyision,or�nce�vide ryunm: <br /> (bj drhether M mir reflise oT is leeally nquired m svppty the faquessed dau:(c)any known oonsequenee atiting from hls cupply[n�or retlitla�ro supplv <br /> p►ivste oc coalldandst d�a;and(d)dte idendty of odie�persons or endoes authori:ed by su+e or federal l�w m rrcCive tha dara. Thf�trquiremrnc shull <br /> noe�pply when tn individud i�nskcd [o mpply fn�eiri;adve daa.pursuuu to ceadon 13.B2,fubdivision S,to�I�w enforcemenc olffcer. <br /> .� <br /> a cnmqtl�.,s{gner P ev,�nue m4� ulace dte nat�ce reauircd under is subdi�isic�n ia �he iMlv(dual income tax or orooam r�+;roKirid <br /> __..r �i1�4�'ctloni i���_4Eon_�o�o Lo�_+�. ' � <br /> Subd.3. A�cees w data by ind(rfdual. Upon r�quesc ro�rcspansible atthoriry,�n lndi�fdu�1 shail ba informed wharher he h the sudjeec <br /> of�wnd drta on iadividuals.aad wMdlar ic it cliss[fted a�publu,ppvate or con!ldential, Upon 6is fltrr!►er rcquea[,an individual who is the subjttt <br /> of storad pri�ue oc pubUc dua nn Indlviduds shall be stiown►he dua wtthouc ury charee cq him end;if he dec(ras.ihsU be infotmed of the wnbent <br /> �nd m6w�ins of��e daa. Aher an iadi�idusl hu beaa shown�he pd�ua dara urd infom�d of irs meanis�g,the dara need nnrba diubsed to dim far <br /> dx s�endu theraafter uiileu a dispuce or action punuan�ao �his secdon is pendlaQ or addirional da+a on ihe indiv[dud hat been oollaced or created. <br /> 'I1is tnpontible�uthpriry tiull provide copies of rhe privz�e or public dau upon nequesc by�he individua!wbJect of d+e d4n. 'Ihe reapons�le wthariry <br /> auy requife d�e mqueuin�persoa ro pay dia aetuel cos�s af maWns-certif�iM.�nd compflln;dte copi��. <br /> The responcible wthority.�tl compiy icnmadiately, if possibk,wich aaY cequest mado puccuant w�hu subdivision,or widdn fiye day:of <br /> �e date of ehe rcquee[.excluding 9uutdsys.Sundays and le;d holldays,if f�spned(aco comptlana i�not po�siblo. Ifhe camw�comply wkh�he requese . <br /> within�hu dme,ho aheU w infotm�he ladividusl,and may ha�e an.ddleiodal flve d�ys wic�in which m wrt�ply wlnc�he requeac,exclud{ag Saairdays. <br /> Swnd�yi�nd k��i holWiy�. <br /> Subd,4. Ptotedur�whitn dnta Is not oceursta or eomplate. An tndlvi�iunl mty corne:t the accunoy or wmpletenoas of pubitc or privaro <br /> dia coacorn�bimself. To exercise rhis right.�n indi4idual shs1)aaily ia wridng ihe respunabk audwri4Y dauibin�ehe naatro of dw dtcagreemcni. . <br /> The�a�en�lble�u�horiry cltell wf�hi»30 d�ys eicher. (q comecc�ie dam found�a he u►iccunte or incwn►plea And icucnpt te nodfy pu�reeipkncs oE <br /> inaeeucate or i�care�plete dpn,lncludln�racipfenu nartud by�t Individud;or(b)tiotil�r the i�ividual thet he belleves the data to be oorreet D�M � <br /> ia d�pu�e dt�ll be disclo�ad only Ef tha indlvidual's mamea�of dlr�[umenc is Includad wi�h che di�closed dara. � <br /> 3'he dotemunation of ehe rcsponsib�a au�horiry may ba appealed pursumi eo�pro�isianc o[rhe admtnicuadve procedum act rel�tint w <br /> concested ctaes. � <br /> � �AT,� PRiYACY ADYI¢ORY - <br /> ln accordance with M.S. 13.04,Subd.2. "Itlghcs of sut'sjects of data', we woutd Nke co inforsn you that your requesc <br /> for a permlt or Ifcense from ihe City of Orono or any of its departmeuts may r�quir�you to furnish certain ptivato or <br /> confidential fnformation. <br /> You are nut[fied that; . <br /> 1. The informatton you fumish wlli be used to dccermiae your qualificacion for the permic orlicense requ�sced. <br /> 2. You may refisse to aupply daea, but refusal may require thac che City deny the petmlt or lict��sc. <br /> 3. Tha information may be shared wich otp�r laeal, sca[e or federal agencies ro the extent necessary tu process <br /> the permic or ltcensa <br /> • 4. . If your requeated peRnit or license reqUirec Couucil eetlon [o approve, some infamiatton may become <br /> ' pubitc. , , <br /> S. You have eertain righ�s unda M.S. 13A4 (available upon rcquest) to rcview private data ofl yoursolf. . <br /> 6, Yaur fiult name is requircd to process,thls application or permit. <br /> . �C C3` ' <br /> ���2--� � �� �_'°� � .�-\ 1 L"`. <br /> vr �N � ' � �1� ���- � � <br /> � <br /> Clcq �— - - Sar�e Zip Phona <br /> ` <br /> ' t•u�tderstand rlgtits as s ove. <br /> 8i�na�uro <br />