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TY OF ORONO � 6124730510 09/24/96 14:00 � :03/03 N0:522 <br /> 3sc_13.04 It1G1iTS OF SUHJ�CTS OF DAT�t ' <br /> Subd. i. Type of dats. 7Re rlyh�s of Wdividud oa whom the 6aa�I�nored or w ba srcred�tiall be Rs see foeth in chis uctian. <br /> Subd.1. Informatlaa requdnd to b�rhae Indi•idml. M IudIvidwl asked ro suPplY Privt,a or aonfidentitl data wnasrcilng himieif,�hall <br /> bs Into�mod of; (t)tho purpoae utd intanded uu ot dle tequesred d�q widda thc calleednQ lnte tgenoy,polldc�al subdlvislan,or�aro+vide rywun: <br /> (b)wfiether M may reftise o1r 4 leeally nquired m supply rhe raquestcd daa:(c)�r�y known consaquenee ariiing from hts cupplyln�or cell�tit�ro supply <br /> ptivsta orcoaMencfa!d�a;and(d)ihe idendry of odie�perso�u or endries authodzed by suie or fedenl I�w m recnive rhe dua. T4Et requlrcmeuc�Iwl� <br /> noe�pply when 4n lndiridurl ii asked co mpply I��e�rig�dve daa.pur�ant ro�ecdon 13.82. subdivision S.to�I�w enforcemenc otfker. <br /> .. � <br /> cnm i sgner QP rey�Que m�� alace rhe nocjcc rcpuircd under{�,'s sybdiviifon ia Uee indlvldual income rax or oroeem nz rellirid <br /> ._ � l�us�ucdon����mxcl uE on�ho�o to E. � � <br /> SuDd.3. A�cest W data by fad[rfdual. Upnn rcquest lo� �espontible suthoricy,�n iadi�iduat shalt be tnfonned whesher 6a u t6e subjees <br /> o[�wrod drta on individwUs.and whtthar ic it elassified as public,p�ivue or conflden[ial, Upon his A�rd►er requeat,sn iadividwl who i��he subjeet <br /> of uored pri�ue or pubUc dw nn individu�ls shill be shown�!u dan wirhou�u+y eh�r�a w him�nd;if ho deslres,ih�tl be infortned of t6e wntenc <br /> ud me�nin`of d��e daa. Aher nn iadividual ha�beaa shown the ndvR�e dara utid[n(omkd of irs meaninR,the dsa need noc bs dlulosed w him for <br /> •ix e�uadu tkerwfter uiile� a dispu�a or rcdon punuuu m �his sec:doa is pendina or addirionsl dan on the individud hu been onllecced or creatut. <br /> 'IUs rapons�ble�uthpriq ciull pro�ide copia of fie prnue or public daa upoa«qveu by�he indlvidad subject of d�e dan, '1?�e re:pans�bte�uthariry <br /> auy requlre the roquestln�pmrson ro pry ihe aeaal cosrs�f maWas.esrtHyin�.�nd eompflia;�e eopN�, <br /> 'ibe irspontible wthoriry �hAll wmply itnmedlately, if possiblo, widi aar requesc medo puccuanc ao d�is subdivision,or widiln five dnys of <br /> d��date oF che royuct[,exctudln¢9uutdays.Sundays and legd holWoys,iP itrunedlace compliana is not po�siWa If�he c�r�oe comply wi�h d�e requesc <br /> wlWlo ctu[c1me.ho ehall a it►form�he ladividuN,and may ha�e�n.dditiodal flve days wid�in which co coroply.w{d�tl�e cequest,exdudipg Sawrdays. <br /> �u�hYi idd le��l holidiy�. ' � <br /> Subd,s. ROtldYw w6i�t1 dolP is net qCetlrit�or COmpletl. An iadfvWwl nay eo�nen�he ucursey or complereno�s of public or privrro <br /> dia eoacorninj bimself. To aeercise d►;s NQht.�n indiViduel shaU notif�in wridnQ iho nsponsibk authos�ty dqettbl��dw nawro of da dl�asceemcnc. . <br /> '[he�vzpea�lble�utlwriry chdl within 30 days eirher. (�)eorrecc the data found ro bc inaccur+te or incnmple�e�nd�aempt ta nodty ptu roeiplenu oE <br /> {miewuts or fn.campleee dpn, (ncludin�recipienu nartud by�c individual:or(b)aotily t4e individuol thst ho belleves the daw co be eotrac� Dant <br /> la dkpua ihall bn discloud anly if the uuflvidwl's atiument of dltaat�eemenc is includod with rhe di9cloud due. � <br /> 'i1�e detertninadon of rhe respansiblo su�ioriry m�y bo appealed pursuani eo�he pto�isionc of rlte adminuendve pmealure act rcl�cint w <br /> concaRed oafes. <br /> ' pATA �iI�C���SOR�I - <br /> L►roecordance wich M.S. 13.04, Subd.2, "Itighcs of subJects of data', we would like to infacm you that your requesc <br /> for a pecmit or ltcense from ihe City of Orono or any of ita departm,ents may requlra you to furnish certaln privaia or <br /> confidentisl iaformation. <br /> '�at are na[iHed that: <br /> 1. �'he informatlon you fumish will be used to decercnine your qualiftcation for the permit or iicease requosted. <br /> 2. You auy rafisse to supply data. buc refusal may require thac the City deny the petralt or licctwe. <br /> 3. Tho informatian u�y be shared wich othor loeal, scate or ftderal agenciea to[he extent nccessary to process <br /> the permic or license. <br /> � 4. . if yout cequaoted permit or licea�e recXuirec Couneil eetion co approve, some infaimatlon may beeome <br /> ' publtc. , , <br /> 5. You have ctrcain rights under M,S. 13,04 (availahle upon nque�t) to roview private data on yourself. <br /> 6. Ynur fult aame is requind to process.thls application or permit. <br /> �—�1 <br /> � ��.(�•��' �-- '���--�- a1� �` � -- <br /> ' . � � � ° �� :�- 4��- <br /> �ry . - �� Z� � <br /> ; <br /> ' (•u ratand my d a�s stased above. <br /> 8igna�ure <br /> i� � ' • <br />