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Apr-21-1003 01:14a� Fra�-CITY Of OROl10 +9522494616 T-314 P.004/004 F-489 <br /> „Scc.13.03 RIGFIfS OF SUBJE:CTS Of OATw <br /> Subd. 1. Type of dsta. 71►e rigba of indi�on whwn me dm is s�ored or ro bc soored shaD be as se�tonh io tbis tec�n. <br /> Subd.3. Iatora�sdon reqaired to be q�m i�i�Idnal. M iodividual as�ed�o wPP�Y Priva�or eot�Cidendal dea cooce�ni�hiraseif tEall <br /> be intbemed ot: (a)me P�epox and iotdyded use of du requested dam wi�io dte wlkcm+E��6e�Y.Po�subdivisiee.or aaawide ryso�m; <br /> (6)whedier he may�eFuse or is Ir.gaity�equiccd w suPP1Y�e�4���a;(c)any bwwn coasequence arising f�m his s,+pPb�B or rctusing w svpp�y <br /> ptivsu or tonfidenual�ep:�nd ld)d�e►de�cY of or�r persons or et�rieas authorised M su�e oe fedecallaw to meivt�he dau. Tlsis reQuiretsent s6alt <br /> noc appty when an individual is asked w wpply iwasdyacve dao,punnan<<o secrion 13.63,suDdivision S,to s taw eaforcemeot otiieer.' <br /> '11►e Cammissioner o1 rcvenue mav ! t the naece rc i n e�shis subd'I�isian in the itldividu8l il+come �or ro aut refund <br /> i�s�cueeions ins�ead ol on rhnse_Pom►s. <br /> Subd.3. Access�o daca by iadi.idusl. Upon requeA oo a rcsponsibk awhorib.aa iodividaal shall be inforr�d Whemer Ife is du subject <br /> of�'roeed daia on individuals,aM whetLer ic is classifEcd ss public,priraa u�coefidential. Upon his further erquesC�n iodividpa!who is d�e subjecc <br /> of smred priv.a or public dan on individwls ShaU be showo d�e dsta wvho�c any ch�rge m him end;i!he desire�,s1u�U be intbcn�d af�e couaeat <br /> ��mzaoing of�hac dan. Afur an individuu 6as bcen sAown�he privarc dau and infom�d of as mewung,me dan�ed aot Oe d'aciosed m him for <br /> six canchs�hereaher udess a dispute or acdoa porsua�u w rhis seccon is pend'mg or addidoaa!dere oa du individurl das been collecud ar creamd. <br /> 't�e respomibk autboriry shull provide coPies of fie p�vaoe or public daa upon eequest 6y dte individud subjae oP d�e dsm. 11►e iespoadble wd�oriry <br /> e�sy requi�e We requesdng parson co pay rhe aenwl cosa of inekin6.cerdfymg.and wmpiling me copies. <br /> . Tha respotuibk wttwcicy shsll comply u+�taediaaly,if pessible,W rth vu7[lQYt9L Illade pttrfuiOL W dd5 9Obdivision,or wi�hia fivc days o! <br /> rhe dax of rhe requou,eseludin�5so�rdayt.Sund�ya w�d legal holidsys.if iromediace complianee is noc pouible. It he uneo�co�nply wirh�e rcq�usc <br /> wid�in�Au ame.he sha11 so iNbrm the individud.and may have an addidoaal C,ve diye Widtin which w¢omply widi tl�e request.exch�ding Samtdays, <br /> Sue�ays a�kgs!hol'edays. <br /> Subd.4. Procedure.�+heo dae■is oot aceWrate or camplae. M iodiridual ma�r eon�ess�he ucuracy or comylednass of puMic os privarc <br /> daa eoneeming himsell. To ea:rcise d�is righc.an iadividual sha11 noufy in w�icing drc respons�ble surhociry descn"bing dw aamre of d�e disxgeeemene. <br /> The responsiblt aud►orisy shall wi�hin 30 dars einc�r. (■)eomec�r!►e dsn found m bc iaaceunre or incompk�e aed ame�ap�m�rodfy pas<<ecipieers of <br /> insc�vrs�e or incomple�e dwu,ioeludtng rteipienrs mmed by rhe i�ividwA:or(D)aoufY dw i�i•iaual�u he belie•es�Ae d�n m be corKcc. Dan <br /> in dispud shnll6e disclosed only U tbe individp�tl's sm�Esnetu of disagtiement is includzd with dte d'uclosed dan. <br /> The decermi�rion or�hc nsponsibk Audwsity maY be APP�ated P�rsu�x to�e provisions af drc�dminis�radve pmcedu�s acc mluing w <br /> eonasoee rases. � <br /> DATa �'RIVACY VISORY <br /> In aecordanee with M.S. 13.04, Subd.2, "Rin.,,h�s of subjeecs of data",we would like�o inforw you chaL your requtst <br /> for a permit or license from ihe Giry of Oroao or any of its depanmencs may require you to furnish cenaia private or <br /> confidential informa�ion. <br /> You are notified th�u: <br /> 1, The informa�ion you furnish wiII be used to decermiae your qualifieacion for che permit or Iieense requesced. <br /> 2_ You may cefuse tn supply data, buc refusal may require that the Ciry deay zhe permit or license. <br /> 3. The info�nacion may be shared wiih ocher Ioca1,s�su or federal ageeieies co the exient aeeessary co proeess <br /> the permit or licease. <br /> 4. If your requested permit ot liceqse requires Council �tion to approve, some iuformatioa may become <br /> public. <br /> 5. You have �;ertain righrs under M.S. L3.04 (available upon requesc) to review private da�a on yourself. <br /> 6. Your full uame is required to prvicess this applicacion or permi�. <br /> � ��� �-��� <br /> �< < �- L.R <br /> t 1� �1 � <br /> �� �� �1�"�- � ���� � � <br /> Ciry Swa Zip Phone <br /> I underscand my rip,bts as scated abo�e_ . <br /> � 1 <br /> Signaure <br />