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Jun-2T-2003 10:44am From-CITY OF ORONO +9522494616 T-T25 P.ODT/009 F-650 <br /> See.13.Q4 RFCiH'rS OF SUH3ECTS OF nA'C'A <br /> ` Subd.'1. Zype af daia. The righrs ei individual en whoro rhe dsts is smred or to be srored sdali bn as sec Po�In p►is secaoa. <br /> Sc:bd.2. Ynformas[on requlred to be giveu ladiridoal. An u�dividuat asF;ed to supP[Y priYate or confidendal dam eoa�crning himsaif <br /> sh31!be informed af: {a)die p�osc and"uutndcd usc vf tbc�qucstcd dan wishin thc oollcering sr�u agency,poiidesi^ubdivision,or sratewide <br /> sysum;(b?wr.cGier Le may r�fuse or is tegaIly required w supply the requaud dau;(c}any Imown conscqueace a�isin�f�om his suppiying or <br /> refusing to a,pply privar..or u�afidena3!da�;aad(d}the ideadty of other persons or endues autlwrizeA by stat�or Pederat law to�ceivc thc data. <br /> T6is rcquirement shail eo�apply whcr.an i.^.dividual is ask:d co supply invesugative dats,punvan[m secaon i3.82, stebdivision S,W a law <br /> cnfor.emenc officar. <br /> . issin cr.'+F rPvemir m�v nt�ce the nnri�e renvrired unde-this Sebdivi "�n in The individue!mcome mx Qr rrnnertv txx reftr.xl <br /> �y�cructipRS j sresd of on[h05 � a. <br /> 5ubd.3. Acc*ss to data by fadividual. Upon request w a respoasible auchorip�,an indi�idual shaU ba info�ute�whcther he is thc <br /> subjeet nf swrcd dara on indi��iduals,ar.d wpethcr it is clauified as pubfie,private or confidoacial_ Upon his ftsrther reqttest,aa ins!ividual who <br /> is d'.e subject of stnred privas or p�.iblie dati on individua'S Sha]I 1k shnwr.fhe data wiSllCuc any cba se ro him and,if he desires,shall be ixtformed <br /> of�he contene and measiin;e��hac dara. Afrer an individuai has been showG ehe privam d�and informed of iss meaning,rhe data need nac be <br /> disclased[o him fot siz mna[hi d�erestur unless a dispu�e er accion pur,�anc ca�his secuoa is pending or additioaal dasa oa tbc individual h�,:bccn <br /> coUzered'or cr�arcd_ The rtsFonsibic actthoriry sFmS!providc copies of�privue or public da�upon cequest by[he individual Svbject of the dau_ <br /> ?he responsib3t aurharity may crquin C�c rrquestng person m pay d�e actual cosis of making,eectifyieg,and eompiling the eopies. <br /> T'Aa respons�blc au�or,ry sh�lt comply immediauly,if'poss:ble,witi any�equcst made pntstsant m tlus subdivision,or withia five days <br /> of thc daee af�he reques�excluding SacurCsys,Sundsys snd legal holidays,if irn�ediate eompliauce is no�possibte. If he casinot compty with <br /> thr rnquest wi�in that dtne, he shall so inform tAc individual,and may bave an addidonal C�va days within which ro compty wi�h Uu requnst, <br /> exCludi.��Sawrdays,5und�y:,aad ltg31 holidsys. � <br /> Subd.4. Procedure whca data is not acc�or complete. Aa indivi�al may coarest�he aecuncy or compleceeess oP psbIic or <br /> privau dara eooceming hirnseff. To exereise flsis righc,an individual shaFt natify in wzuing dse respansib[e authoriry drscribing the�ature of the <br /> dis��eemena Thc sespoasiblt sudwricy shali withie►30 dsys euher: (�carrecc�he dam found to be maoauate or ipcamplete and attempt tD norify <br /> pasc recipicats of inaccvra�e or i�complo�daffi,i�ludin�recipients namtd by the it�dividual;or(b7 aodfy rhe individna!d�a:be betieves sha dan <br /> � co be carrcec Dam in dispucc�haU he disc[osed oaly if�e individuaE's s�wmcnt af disagreamea�is irxluded widi etse disclosed data. <br /> T!r_de:crminaaan oP d�e rcsporsble auchoriry may be appealed pwsuant to the provisions of rha sdmuvsuadve proccdure act rdadn,r, <br /> to conres�ed cascs. <br /> DATA PRTVA(;Y ADYISO�t''Y. <br /> In accordance wit,�i�t.S. 13.04, Subd. 2, "Rights of subjects of dat2.",we would like to inform yoa that your <br /> request for a permit or license from the�ity of Orono or�ny of ics departments may require you Lo fux�lish eer�,aia <br /> privace or confidential ittPocmation. <br /> You ue notifiod tt�at: ' <br /> 1. 'T'he information you furnish will be used to determiz�e your qualif�cation for Uxe pdrmit or Iicense <br /> requested. ' <br /> 2. You may refusa co sugply data, bu�refusal may require thac ihe City deny ths permit or license. <br /> 3. Ttce information may be shared with other lxat, state ar fede:al ageacies to the ezteat necessary to <br /> process ihe perm.is or licease. <br /> 4. Yf your suquested permi�ar liee�se requires Council action to approve,some informat�u may become <br /> public. <br /> S. You havc cer�aia rights under M.S. 13.0�(availablc upon request)to review grivau datx on yourself. <br /> 6. Your full name is required to process this apolication ar permit. <br /> Q��:� ���: ���a �-�-, ��s L���; ��s - - <br /> Firsc Middie Last <br /> 3�Z c�r�,�4iJC�-e ,�•�R-• / <br /> wildres5 / <br /> , �, � / /1'IN `�53�v �� 3- �7�'- �i/ �`� <br /> City State 2ip Pbone <br /> I rssand my ri�hcs as s ted a ove. <br /> � �� <br /> , Ssgasmre <br /> � <br />