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TY OF ORONO � 6124730510 09/24/96 14:00 [�1 :03/03 NC�:�522 � <br /> Sec.13.04 RIGIfiTS OF SUBJ�C'fS OF DAT•� <br /> Suhd. 1. Type o�dat,. TRe dpdts of individud on Whom the data i9 smred oe ro be srorc�i sh�ll be as set fonh in this�ecdan. <br /> Subd.1. WoRaatloe riqsdr�d to be�Ir�n iodiofduzl. M Individurl esked to supply privere or oon�ideeriv daa cancsmUfg himaelf thall <br /> be�nfo�oft (i)rhe purpose�nd intendet!use of the Tequesral dan within the cotleednQ 9n�e agency,poUdcal aubdlvision,or snte�vide rystem: <br /> (b)wfiether b�may re�use oT is legdly tequired co supply 1he roquesud dou;(c)rny knoa+n eonuquenc:e arising fmm his supplyln�or�efUaing ro supply <br /> privsu or coaAdencfa!da�a;and(d)�ha idonnh of od�e�person�or endoes aurhorized by su�e or feder�l 1�►w tn r�eeive�he da►a. Th[�requireme��shull <br /> not apply when an lndividuet is nsked�o fupply U+�esrig�dve daa, pursu4n�co cecdon l3,B2, sut+division S.to�laW enforcement o(P[aer. <br /> 'jh,,��missivnei�i�e.enuc mav alace �he nory'ce r� i d under this subdi�isiQ in individusl income rax or aroosm�ma,��+nd <br /> �i1E�l�S���L�Slacead u�on t�to�,�jQr i . <br /> SuDd, 3. A�cets to dpta by ind[vidwl. Upon rcques�to p �espansible suthoriry,�n iedi�iduat shail be informed wherher 6e le ihe subjecs <br /> ot�wrsd dau on indlviduals,and whe�or it is clzssifted a9 publu,privace or conPlden[ial, Upon his ft�rtl►er oeques[,an individual who i�rhe subjtet <br /> of twrod pri�ue or publlc dp�a nn indlviduals sFull be ehown the dara withou�any char�e w him and;iF he de:lres,sha11 be infomted of the wn�en[ <br /> �nd mtrening of dut dua. After�n individua!hu been shown ihe printa dnw and iafomkd of ita mesning.the dara aead noc bs diaelosed to him for <br /> d:ewnfis thereafur unlet� a dispu�e or acrian pursuan�m�his seerion;s pendin�or addirionsl daoa on�t►e individual h�s been eollecred qr created. <br /> 71�a rsepuneible�uthpriry chall pro�ide copies�f rhe privare or public dara upon requesc Sy�he individual subjecc of die dara, Tht reapnnsible aatho�iry <br /> rt�ay requite et►e reqUealin�person ro p'y a+e aemel cosu ef mak(ng,certifyinQ.and eompiliag d,e copi�s. <br /> The xspansible su�horiry shall eomply immediacely, if posaible,wi�h anr request made pursuant m rhis subdivision,or wi�hln fi�e days of <br /> �he date oF che requesc.excludinQ Sacurdays.Sundays rnd leg�l holldaya,if immedla�e compliance is not po9sible. INhe canno�comply with�he roques� <br /> wlrhln tha[dme,ho ahall eo inform eha individual,and may ha�e an addlrional five days wld�in which ro comply wi�h the requesc,excluding Saa�rdays. <br /> Sundtya And le�wl holld�ye. <br /> Subd.4, Roeedure wh'te dnta is net ocewata or complete. An individual m�y conmst the aecuracy or complaeno�of public or priv�ce <br /> d�a concernrn�bimselt. To exercise ehis right.on individuel shal)noaly in wridnQ�he rosponsible wrhudry�escribl��d�a nentro o(the dtsagreemen�. <br /> The rexpon�lble ruthoriry sltell wid�in 30 days eirher: (t)cortecc rhe dam found�v he inaccutate or incomplue And etcempt to nodfy piut recipfenes oE <br /> iaaecunte or incarpplete dpn, Includin¢recipienu named by rhe individual;or(b)noafy the individual ths�he belleves the darn co be oo�rec�. Data <br /> ip dF�pum aAall be disclosod only if tha individusl's sra�emenc of disa0reemenc is included with�ho di9closed dara. <br /> 'i'Me detemunntion of�he rrsponsible.u�lioriry m�y bo appealed pursuani eu the pm�isionc o/rhe adminisuarive proeerlure ect roladng w <br /> aon�ested caees. , <br /> � pATA PRYVACY ADVISORY_ <br /> !n aecordanee with M.S. 13.04,Subd.2, "Righcs of suliJects of data", we would like co inform you thac your requesc <br /> for a parmic or license from the City of Orono or any of its depaltments may requira you to furnish certain privato or <br /> confidential information. <br /> You are natified thar. <br /> 1. The information you furnish will be used ta decermino your qualificacion for�he permic orlicense requested. <br /> 2. You may refvse to supply d:ua, bu� refusal may require that [he City deny the permit or license. <br /> 3. The information may be shaced wich o�her local, srate or fedetal agencies to the excent neceasnry [o process <br /> thc p�rmit or license. <br /> � 4. . If youT requested permit or license requires Council action to approve, some infarmat[on may becomc <br /> ' public. <br /> S. You have cenaln righcs under M.S. 13,04 (available upon roquesc) to review private data oa yourself. <br /> 6, Yuur full name is required to process tbis appljcaiion or pemnic. <br /> , . . <br /> � �� . <br /> , Firt�� � � ) .[1 iddle�-. � : ' r Gac. <br /> 1 �1 l <br /> �/��/ <br /> �� , ' � � ��. � � � <br /> Cl' So�e 2ip Phon� � <br /> �� ��� <br /> ' I•underatand my s as s[aced nbove. <br /> � . , <br /> Sisn��un <br /> D,.,.. . .._ .1 m�. n n� . �nn�r n_ � i in� � .. . . ....... <br />