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.,F F. --i`=i T�Hi! 1 � �:� F'l��i I��.k rrE' ; ,�F"F'L I:�i��I�."E F.��,;�: Id+='�, �;� �;�,��i �;�;il r� F�, ��
<br /> � �ti i r "u� �Ku�� '�' b12249461b 04/�2/99 13:48 � :OS/05 N0:837
<br /> aea��.as nrcH'f3��su�crs a�nA�rw
<br /> Sut�d. j. �'Y�O(d�h. �'}�tl T1�IItd Q�ilfd'lVldyil oti Wb0{!1 m6 Qa.(a ts�tDiD�i pf to D�s4ored ehqll ba As wt fvitlA IJA 1hi1 6CC�iCn.
<br /> SuW.�, 1n[oc�nulou rcq�ed t4 be�r�ra�,�viqu�J• A.q t�dfvlduel rtstc.d w supp�y privi�a ar ov�dentlal Aacx ca�carnin�bGusel!�ha�1
<br /> e�Fasfenned of: {a)we purp�se er�4 lntandai uae of uF.srquesscd Caa�wtshin tlde�nUrcw+g 6uta e�arwy,palldc�l�Ubdi�isien,or�utawlde ryercm;
<br /> (b}wf�eil�rr?,e m�y�cl4+r ur i�1aA�llr.equkred so supply U�n,cque�xai Cota:(Cl isy knowr�contequtn�e�rlxkng tr.rm hi��upplyln6 nr reN�[np to s�iPP�Y
<br /> p�i��to or wnC��faaoe!daw;a�,a(Q)me idenaiqr ot a�her persoaa ar eaades authotuan Ry sta te or fcder�!law�o receive trie dan. 'tltil9 r�qul�tment eeall
<br /> not�pp1y�uha��n�ndivipual{i�,pked rp wpply�nveSr}gadva d,Q.puRut�tt ttl st�Aoo t3.82, 9UDC1IVIflQA a.fq t I�W pn(9TC0�10RS O�ACtf
<br /> j$g cumm��Honer o[,�vy�e a�y�+l ct.Iht[�s�j�}�Irt�{ �hdOt.�s _ , ! t ion���tiie ineJ�tdukl_la4A"14 nx �r p%���a.s rewnd
<br /> I�liiYlCf�Of13 ln�(j,�Ql1�P�9[o ,tRtiS.
<br /> Subfl, 3, Aeesr Yo A�tn by Indl.idurf. Vpon rayy�st to■nepvnt�ata wA,aruy,rn{ndi�idu•l sUa[F be 5alorme4 wReM�er rn Re d�6��hjea
<br /> of ituroQ�dc�on iodSvislqtlr,uu}whQ�Aer ic ic rlASSlAra 9s public,p;;vAu or caaACenria�. Upon hts N�rr requcu,�n irallvidual who[6 d�e subjec�
<br /> u1�w�+ad prfv�to or public dpta on ltW�vtQutl,��doll ba.slwwn�ha d'xta w''tlliout Any cbllt�e to him�u1e1;ll rte do�irsf, shall bo fnformsd at tr�e con�aa�
<br /> 4�fd 1'n�aain;of tMe data. Afl�r u�inAivi�ival hai bea��shown ihs privrte eaw an6 fn�0emdd of i�a ox�anin;,d,a dasa nc�ed rtot�e dlsc•�oeed w kiro Co.
<br /> �Ix mopths there�flar ardc+el�dupp�e or.cuoo por�unnt to 1Ai�sccho�py pending or ad$itronxl dat�Qn the�Qi+r;du.l h��beee eallat�d or ertnmd,
<br /> T't�+toFpaiuiAta�u�hqrfry op�li provido copk.of tfia pn�aw or puDli�dpa u�+an royuosr Ny the lndividual iubfoct oftho cfAta, 'I'he raspa�wdbla ou�orlry
<br /> MsY�'�'OuVr�t tht«�ryestin`penon�n pty�he acrosl cou+of makin�,certifyiry{,und cocnpiling�he coyiea.
<br /> 'Y?�e r.a�vnsibta suthoriry she11 cpmrly irnmediII�ty,li pouiDle..with apy rrquest rnrde pun�uant{o tl1i�tuba{vision,or wi�hfn tive dpys af
<br /> � [h�dif�oPlhe raqu�rt,axr.ludfag Satvrdsys,SumSaye xnd le�a7 lneflday�,ff immadln�e anmpllance ie noc pos�ibfe. 1lde cae�n,at comply wtth tha re�uadt
<br /> wi�u�d►�t dme,bn ahell a�h�form ihe lndivtdual,arld n,ay hivs xn��dicionAl Cve�ays w;�Rin which eo compfy with tMo mquas�,e��iuding San�Naye,
<br /> Sund�Y��nd Ioi.1 hotfdAya.
<br /> &n�d.d_ prac�dure whep da.tr!�not accurnte or eemgt.�e. An individual m�y canusr Ute securacy or cnmrleteness o[publ[a or�+rivare
<br /> a•uc ca,rcerntnR hin,elf. 70�xareise n�h riRhc.�n inui��n�v sna;l nonry in wncsn;u�..e�nsib�c nun�u�ry doscrlbing d+�n4wre of Eto disa�rcomen�.
<br /> 'Y'h�ra�wn�tbla wtlto�ry xhall u�i►hin 3�1 daY c etchet; (a)cortect tTie daw fnu�scl te be iartcur�te c+r iocompleu�nd urempt w nudfy pees reciDients ef
<br /> 1nA�4r'aUf oP 111coinplata d�li, inclvdins rcolPir,ncs nAmed by�he ied[visival;or(h)nodfy�e indlvldnel��t ha btlSeves the d4ta to be correc[, DQ�n
<br /> In di�puro shAll bo di�clasee onry il�e indtvi��l'f�tx�emen�o(die��etetrt�nt i�Intluded wifh the Oisclosed deu.
<br /> 12ie d6tE]'m�t111btt of the T¢spvn8ibk�u�hariey mry De eppsaied pursu�rir w the provixions of rhe adm4ilcaative�ruce0ure a«rr-farin�tn
<br /> carlltsOCd cll;pa• .
<br /> �?t��p -�'-..l�;�Y Ai�YTSbRY
<br /> ' la ao�otdance with M.S. 13.a•�,Suhd.2, "Rights of subjeccs of dnca", we would Ilke co irtPorm you that yqur request
<br /> £or a permlt or IScense frum ►fia Cicy of Urono at any af its deparcmen.�s may require you tu fur�lsh ce�tain privata or
<br /> cnnl"idential infarxrlq[.ip�.
<br /> You Rra no�iP'ied that:
<br /> i. The lnformation you furnlyh will bc used to detcrmina your queliflcation for the permii or Iicrr►�a requested,
<br /> 2. Yau mar reSise ep supply dac�, hut rsfusal may rcquire ihac lhe City deny �hc perrnit or]icense.
<br /> 3. '(�te infuCmq,tion ttiqy AC.shared wfch oChc[2oCpl, s�a.�e or fcdcra! a��ncies co the Gx�e•nt ne�tssary �n pr�cess
<br /> �hc yctmi�or ticensc,
<br /> �, iY yaur xequesttd pertuit or licensa xtqultes C:ounctl acrion ►o �pprovc, some infarmation may become
<br /> publ9c.
<br /> 5. You hav� ttrt�i�1 tights unr.l�i M.S. 13.04 (availitble upon re�uesi) tu revicw privAte dnta O�yoursetf.
<br /> 6. Yo�r ful.t name is rcq��ir�d to�roc.ss this a�pifc�i�on or permii.
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<br /> F1r�t Mtddle Lnec
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<br /> Clry � Stara Zip PhOn4 �
<br /> I understrntd my �igbts Qs �tated abovo.
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<br /> s�anaa�r�
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