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yun-24-2003 05:13pm From-CITY OF ORONO +9522494616 T-TOT P D03/003 F-605 <br /> Scc.13.04 R1CT�1'S OF SIJB.�ECTS OF A.aTA <br /> Suhd. 1. Type o[data. The ngdu of ir�dividusl oa whom the dau is swrcd or m be swrod shall be as set farsh in�his secnon. <br /> Su6d.?. �o�mstiun required to bc givcn tadiridual• �+n ind�viduat askcd io tupply pri�aoe or confidenoal data coaccraing hiroself shsll <br /> be infocmcd of: (�)the purpose�nd'tntended use of rhe requested dew w�dtin thc cotleclitig*�tatc 9BCttcY�Polidca!subctivisioo,or s�stewide syscem; <br /> (b)whe�her ha may refuse oc is iegally�equind�o supp►y�hc c��uesced data;(c}any laeown conuquenee arising from dis supptyiag or rctusing rn supply <br /> privace or confidennai daca:uid(d)ch�idensiry of oeh�r penons o�encues au�horizcd by s�a�e or fzderai law co rcceive�he da�a. 7tus requireroeoc sheli <br /> n�c apply when an individu�l i��nskcd co supply invcsngacve dan,punw�nc�a sc:aon 13.82,subdivision 5,ro a law anPoccemem o�c�r. <br /> The co m'SSIO�er c f rtv@pue m�v olaCe th0 nnnce reouircd Undcr this subdiviSion m che individud� il�come nx or OroOtiry rsx +efund <br /> instruaions instead of on ehose (ortna. <br /> Subd.3. Aceess�o d�m by individual. Upon requesc ro a responsible�n�ho�h,nn individual shall be infoRned whe�her tte is�c subject <br /> of s�orcd da�a on individuals,aM whether it is cla�siPed as public, prirace or con��dential. Upon his tunher requesc,an individual who is chc subject <br /> of scored pnvnce or public darr on individunls shall be shown�+e d�n wi�houc a�y charse�o hvn and,�if he desires,shall be informed of the concen� <br /> and mcaning ol d�ac d�. Af�er an individuN has treen shown�he p��are dasa and infortned of its meaning.the ds�a need no�be discloscd w him for <br /> sjx mond�s d�ercaf�er uNess a dispu�e or scrion pursuan�eo rhis secdon is p�nding or addinona]daa on�he individual Das been collccrrd or crea�cd. <br /> The rcsponsible au�horiry shatl pto�ida copies vf�ha privau or public dau upon reques�by rhz individual sub�actof the daca. The responsi6lc aut�oriry <br /> may rcquire 11se rcqu�scing person co pay the aetual cos�s of making.ccrdfying.and compilirtg�Dc copizs. <br /> Tha responsible aud�oriry shall comply immedia�ely,if possible,wi�h a�Y te9ue>t made pursuanl m this subdivision,or W�dtin fi�c dny6 oP <br /> the daec of rhe�cquest.excludiug Sa�urdays.Su�ays and ingal holidays,if immedircc compliance is no[possiDla JS he cannoc compty with ehe requcu <br /> w;�hin�haz tin�e,h�shall so inf�rtn�he individuat,and may hsve nn addidonaf�ve days with�n w�ch to comply with tAe rcquest,excluding Snnardays. <br /> Sundays and lesal holidays. <br /> Subd.4. Proeedura whce daca is noe aecurn[e or complete. A�+nd;vidual may eonces[rhe accuracy or comple[cness oP public or priva[e <br /> dacr concemins himself. 7o exerciu th;s oghti an individual shall naufy in wriung rhe responsible eu�horiry dcsenbing the nature of tha disngrerment. <br /> The respons;ble au�honry shall wi[hin 30 aays eicher. (a)co�cc ihe dan found�o bc inaccum[e or incompteie and aacmpt eo nonfy pas[«cipicnu of <br /> inaccure�e or incompleee da�a,inetuding recipienu namcd by tt�e individual;ot(b)rto��fy�e individual that ha beliaves�hc dan[o be corKcc Dua <br /> in dr�pucs sha11 be disclosed oi�y if tht uidi�idual'�sntemen�of disagreemrne is inct�Qed Wifi rhe disctoud dau. <br /> Tl�e dc�erminarion af rhe cesponsiDle au�honry may bc appcaled pursuant ro rhe provisionc of rhe�dminisnadve procedure act�ladng eo <br /> contasred cases. <br /> DA'I'A PRNACY AAVISOTiY <br /> Cn accordance with M.S. 13.04,Subd.2, "Righ[s of subjec�s of daca",we would like to inform you chac your tequest <br /> far a permit or license from the City of Orono or any of its departmen[s may require you ro fumish certain private or <br /> cor►fidential information. <br /> You are noGified thac: <br /> 1, The infonnacion you fumish will be used to de�ecinine your qualification for ihe petmit or lieense requested. <br /> 2. You may refuse ta suppiy tlata, buc refusai may require that the Ciry deny the permit or license. <br /> 3. 'fie infonnation may he shared wi[h o[her loeal, s[ate or federal agencies co che extent necessary to process <br /> the permii or license. <br /> 4. If your requested permic or license requires Couaeil action to approve, some informa�ion may become <br /> public. <br /> 5. You have cer[ain rights under M.S. 13.44 (available upon requesc) co review privace da�a on yourselP. <br /> 6, Your fall name n zequired ro�r�cess ttiis applicatiaa or permit. <br /> t,,;,t� _ _ Z.,1 ; �c��_ <br /> Fitsc �tid Ic � ^ Lust <br /> v�,�� �..� ��� <br /> Add ess ' � v� S���, l f � , j �-� <br /> � k, .. <br /> Ciry S�« 2�p Phone <br /> I unders[and my r�ghts as statrd above_ <br /> , _ , -, <br /> � � l�-� �v.C� � � J���g•�-- � � �C% . C�C � <br /> $ignaNfe n <br />