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Nov-08-Z001 11 :27am From-CITY OF ORONO +952Z494o16 T-152 P.008/008 F-904 <br /> Scc.13.04 RIG'ST5 OF SUSJECTS OF DATA <br /> Subd_ 1. 7ype ot daca. Thc righcs of individ�sl oo whom ct►e da�a is sroced or cn be swrcd shall be as se[forsh in�his secrion. <br /> $ubd;2. InPo�tioo required w be given lndividual. a�r,individual askcd w stipply pri�aie or confidenrial da�conceming hisnself <br /> shall be inPo[mtd of: (a)the purpose 3t1d incended use of thc rcques�ed dara wi[hiu thc cotlecting smee agency,polirical subdivisian,or sracewide <br /> sysum;(b)whe�her he may reftise or is legally rcyuired io suppIy che requcstid da�a; (c)any known conscquencc aruing from his supplying or <br /> rcfiuing m supply priva�c or conFidennal dsed;and(d)the idcndry of oshct penong er e�tidcs aurhorizcd by srara o�federal law co receive nc�dan. <br /> This rcquiremcnc shall noi apply when an individual is asked co supply invesdgaritie data,punuaa�co scccion 13.82, su6division 5, ro a law <br /> enfuccemen�officer. <br /> 21ie cn micsioner�f revern�e mav pl ce tf�e nodcc r n�ired under�hic a�hdivis o�n_thc i d�i��i�ius�inenm�rax or Prooeriv�ax reft�nd <br /> inRrructiQns inst�ad af on th�se f�9. <br /> Subd. 3. Access to data by individval. C�pon rcqucs�w�responsibte aurhociry,un indiv;dual shaU be informed whethcr he is the <br /> subj�cr of srored da[a on indi�idusls,and whaher it is c(assificd as public,pcivata or to�dential. Upon his fur[her teques�,an individual who <br /> is�he subjee�of swred priva�e or public dara,on individuals sha!!be shoxn�lv:data wi�houc any chargc co him and,if he desires,shall ba inform�d <br /> oP rhe con�ens and meaning of chut daca. After an individuat has bee�.sfiown dx p�ivA�e dan aod infocmed of ics meaning,the data need not be <br /> disclosed�o him for six monihs rhereafur unless a d"u�ure or action pur,�an�ru dus secQon is pending or addi�ional data on rhe individus!has been <br /> collce�td or crea�ed. The�csponsiblo audtonry shall provide copics of�he pri�are or public da�upon rcquect by the individual subjccc of�he da�. <br /> The responsible aurhoriry msy rcquire the r�quesring perso��eo pay die accual cosu of mutiing,ccrcilying,and campiling�hc copizs. <br /> '[�c responsible auehori�y shall comply immed;ately,if pass.ble,wirh any raquesc madc pursuant w rhis subdi�ision,or wiittin five dsys <br /> ot che da�e of rhe requesc,excluding Sacurdsys.Sundays and IcFal fu•liday;,if;:nmedissc campfiancc is not possible. IP he eannoc comply with <br /> rhe requas[within ihac dme.hc shall so infocm che individu�l, and raay have an addi6onal ftve days wichin which w compty wi[h rhe �eques�, <br /> eacluding Sa[urdays,Sundsys and leg�l holidays. <br /> Subd.4. Precedure�shen dota is not accurate or cumpt�_te: An w.di�idusl may con�es�the accuracy or comple�eness of pvblic or <br /> priva�data conceming himstlf. To cxer�ise rhi:righ[,an ir.�ividual;hail nocify in wridng�hz responsible aurhoriry deacribing nc�nacure of rhe <br /> disagreemenc. 'ilie ctisponsibla authoriry shsll wirt�.in 30 days cichcr: (�)cot=cct rhe da�fowxi cn be inaceura[e ot incomQle�e and a�temp[w noat�' <br /> pas�recipienrs of inaccurate or incomQlcx daa,induding recipients m.�mcd 6y tht individual;ar(b)neufy the individual thac he beliaves cho da�a <br /> co be correct. Daia in dispu�c shall bc disclosed only iP the individu:�!'s statemcnc of dieagreemenc is includtd with the disclosed dara_ <br /> 'l�e dcurminadon of fic responsiblc sutlwriry may bc app�:aled parsuant w thc provisiuns oP the adminisrraave proccdure ac�reladng <br /> w con�ested cascs. <br /> T�ATa P$iv acY AnvrsOT�Y <br /> in secordance wiLh M.S. 13.04, Subd. 2, "Righc;of subjeccs of da�a", we would like to inform you that your <br /> reques[for a permit or license from rhe �iry of Orono or any oi its deparnnents may require you to furnish cectain <br /> privace or confidencial infomzacion. <br /> You are notified that: <br /> 1. The information you f�,�rnish wit: be u:,ed to determine your qualifica�ion for the permit or license <br /> reques[ed. <br /> 2. You may refuse co supply data, but reh�sal may requir: chat the Ciry deny the permit or license. <br /> 3. The informacion may be shased with oiher loca:, sta[e or federal agencies to the extent necessary to <br /> process che permit or lieense. <br /> 4. If your reques�ed permit or license requires Council action�a approve, sotne informa�ian may become <br /> public. <br /> 5, You have certain rights under M.S. 13.(r4 (availabie ugon request) to review private data on yourself. <br /> 6. Your full name is required to process uiis application or permit. <br /> G� ` �� 1�f2_ � T� � <br /> Firs[ �tiddl: Lasc <br /> ����--� L1�-�C-��/'`,►� t`� � �- � <br /> � �� <br /> waaM � �, ,�� �S'`/a-rJ �6 3`�� �—CY�� � <br /> ��ry g�Le Z;p Phone <br /> I understand my righu as ted abo <br /> r <br /> Signs[urc <br /> 6 <br />