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J � • <br /> Scc13.04 KIC.fITS OF SUHJECi'S OF DATA <br /> SuMt_1. Type of da W_ Tdc righ�a of individual oa wlam�hc Anla ie aW red or lo ba slored slull be m sd foM in 16is scaion. <br /> Subd.2.In&nmaliontaquiiedwbegivrn'a�dlvfidual.Anindividuslaakodtowpplyprivateorconfid�tialJalaconce�ningLimeulfelwliba <br /> informed oF:(a)the purpo�e and inlmded uac of Ihe coqumled dala wilhin 1l�e colleeling aL�ta aganey,PoGtiml au6divirion,or a�aluwida xyelum;(b1 <br /> whethv Lu may rcfwc or ie legally requirod to supply the reqeo�led dota;(e)any lmown ooroequence arhiag fmm his sopplying or refiuing ta supply <br /> private or confidemiai dau;and(�IAe idrnthy ofelher pusanr or entili�s auUwt'sad by aWe orfadmal Iaw W raoaivo Iho da1a.Thi+�oquu�tinant�hall <br /> not apply when an individual ie aakad to supply itrvcdtigative da�i,punuaet to�ocliw�13.82,eabdivieian 5,to a 4�w cnfarcement ofrcer, <br /> '[1�c eommiaaiogcr of nsvenue mav olaae Wc notiee raaaircd nnda Uus subdivtaion in 1he indirvidual inoomc!ax ar pmocrtv tax%u�d <br /> inalntUiona inalcad ofon Ihosc fonro_ <br /> Snbd.3.Acecia w dau by individuaL Upoo requast b a n.wpons ble aulh�ity,an individusl ehail6n infom�ad wt�eU�ar hv i�tho Aubject of <br /> nla�ed dita on mdividuale,and whahcr it is clasRified aa publie,privrle or cortRdentiaL Up�n Iria funt�a eequal,an individual wIw is thc subjcet oC <br /> xlnral privalc nr puhlic dal�oe indiviJu�b cL�tl bc�huato IMe daLt wilheut aey durge w h'rn and,ifl�edcainr,sl�all bo informed ofUw codonl aad <br /> mr�ning nC thal dau. AQa an individua{h�boen edoan�l�e privatc dau and infort�pl of ils mcaniog,tha dala neaet not be diaclmed lo bim for six <br /> mon�hs Il�e�esllerunieee a d+epum or action punvant w this eection is pe�diag or addilional dals on Ihe indi�riduel h�s baan collneteJ or crwted. '[1�0 <br /> naponeible a�Mo�ity alwll provide eopiw oCthc privatc or public dala upan roqueat by{hc indivulual aubject of U�c dala. 'tl�e rapa�4ibk autLorily <br /> may roquirs Wa roquasting po�son b pay!ho actual eoels ofmaking,oe�tifyiag,and compiling Ilw copies. <br /> 'fhe ranpoar�lo au�orilysfiall enmply ima6d'aloly,if peseible.wilh m�y raqnmt o�s�to pmwanl lo Wis aubdivisioa,orwithin t"ne days of <br /> Iho Jale oClho roqaol.excludiag SaWrdays,Sundaya and legal hdidnys,if immad'rrlc oamplisnen ie not poeu�b.If ho cannot compfy wil1�lha rcyucst <br /> wiU�in U�n�time,lK:ahallw in[mmlhc irtdividml,and may have an nddit�onal frvedays wilhi�whicli W comply wilh 1dc csyw.,��tcludingSalunLiyx, <br /> Sumlays and legal holidays. <br /> Subd.4, Proodlurewlxn�labieaotaacurtLeorcamplefe.AnindividmlmayeoalmltlioaecuraeyoroompkbnonofpubGeorprivaleJatn <br /> rnnxrning himaelf.7b cxctcieo U►�rigl�An in�i�idual ehall nolify in writu�gthcrmponaibleaulho�ity dacribing thc naWn:oCU�c dixagta,titwnL'('he <br /> rc�sponxibk awhori�y shaU within 30 days eiUicr. (a)coircet Uw data fowx!w bc inawurxa or ineomplo/a and a14�apt to aotify pmt racipianL�ol" <br /> inaocuraleorineanpleledaL�,includingrecipientsnamedbylLemdividual;or(b)notit�eheindividmlUuthebeliavmlhad�lato6eaonocl.Dalain <br /> dispwc shall be diseloud only if d�e i�ulividual'a da�ama�l bf disagtewnaU is ineluded with If�e dmclaeod da�a. <br /> 71�e dc�rnn6mlion of thc naponsble au1lwrit�r twy be appoled pwsuanl tn the proviaions oCtbe admininttalive pQoixJu�atA nlaling la <br /> conLLwlul caaCu, � <br /> DA'E'A PItIVACY ADVI50RY <br /> In ucconlance with M.S. 13.04,Subd.2,"Rights of subjects of dala",we would like to inform you lhot your rcqucst <br /> lix a�x:nnit nr licensc from!he Cily of Orono or any of ils dc�mrlmenls may requim you la Curnish c:crWin privlite or <br /> ccmlidcntial infotmution. <br /> Yc>u arc noti�txl U�aL' <br /> t. The infonnaticm you fumish will be used to deternune yoia c�ualificulion for 1hc pern►il or licensc <br /> requcsted. <br /> 2. You may refuse la supply clala,but refusnl may require that the City deny the permit or license. <br /> 3. "fhe information may be shsrod with othet local,sfnte nr fnderal agencies to the cx�nt necessE►ry to <br /> proccss the permii or licenso. <br /> A_ If your requesled permit or license requues Council action to approve,some information may become <br /> public, <br /> 5. You have cedain rights vnder M.S. 13,04(avai{able upon rcqucsl)to review private data on yourselt: <br /> 6. Your fiill name is requirrd W process this application or pennit. <br /> l P��c.Q �rr�';� ,�n,r ,nc�a_�4'd�.��.s-�e�'rtS 4��� <br /> Nirni Middle L.�st <br /> --�D l� ��e rX.�s�2�- �� Gc> <br /> AJdreay / � <br /> �U W��• i � l , V �V �+ �' � 3a-o--y�yr��� / <br /> Cily State 'Lip Phonc <br /> I understand rny right�as stated above. <br /> �. ��.c( <br /> Si�atnre <br /> x��r•om, az <br /> E 'd 9688bL60zE vuI uot�epuno� itqa�l dBE =bO BO Bz JeW <br />