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CITY OF ORONO � 6124730510 12/04/96 12:33 � :03/03 N0:410
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<br /> Sec,l3.04 RIGH7'S OF SUEITECTS 4F DAT,1
<br /> Subd. l. Tyye of daa. The rith�of individuzl on whom rlie data is s�oced or to be 9�orsd shall be as�ei focth in this sccdoa.
<br /> Subd.2. Ia[ormatioo required to be giren indlridual. M indlvidual asked to supply pri�ace or co�dendal dau cancerning Eimsetf shall
<br /> be infontied of: (a)the purpose�nd imm�ded use ef�he rcqucsced dara wlthin the eofleccing Y�ate agency, policica!subdivision,or sucewide syscem;
<br /> (b)whe�hec ho may rtfuse o'r is legally rrquircd io supply rhe cequested dsta;(c)utY fcnoum consequence arising frnm his supplying or refusing to suppty
<br /> p�vaee or contldencial dan:and(d)dte iden�iry uf o�her pccsons or enriries tu�horizr,�l by sn[e or feder�113w ta rtceire the dAta. This requi[emen�shall
<br /> not apply whon an individual is asked w supplv in�esdgadvc da�s, pursuant to secuort 13.8?, subdivixion 5, to a liW enCorcement otfieer.
<br /> �� �•pmm���ioner of revenue mnv pIOC� the narice reuuired under�l+is �ubdivislon in �}+� indiY�duol ir�urte ux�,�,eca�e[tv tnz re_funG_
<br /> �istruccion9 inYceaqyl on�hos�loccns•
<br /> Subd. 3. Access to data by indtvlduai. Upon reques�t�a responsible auchoriry,an indi�i3us1 shnil De lnformtd whether he is the subject
<br /> of s�orrd Jan on individuale,arui whe�her i�is dassified as public.pri�a�e or canfldtntial. Upon his fuRhcr requesc,an individuel who is ehe subj�ee
<br /> of s�ared pri�a�e or public dau on individuals shstl be shown�he dara wichou�any cha�e co him�nd, if he desires, shaU be infortned oP fie eancone
<br /> and meaning of�hai dar�. After�n individual has been showrt the prlv�u dav and inPormc�i of its me�nin�,the da�s need not be dltclo9cd eo him for
<br /> 9ix mon�hs ehereuAer unlc�s a dispute or ncriun punusnc eo�his seetion is pending or addia�nal da�on�he indi�idunl has heen cofte^ubferau�hon�
<br /> 'Ihe tespon�ible�uthonry shall providc copies of che privaa or public dan upnn request 6y th�individual subjocc of the da�a. The resjw ry
<br /> m�y require rhe requss�ing person�o pay �he acn,al coscs ot rr,�king,ceRifyins,and compiting �he copies,
<br /> The rasportsible ait�honry shall comply immediately, i(poesible,with any request made pur5uant to rhis subdivision, or witl►in five diys of
<br /> yo dat�of i2te request,exclu�iln�Sacurd�ys,Sundiys ind legal hulidays,i!lmmedia�e eompliance�s nat poesible, if he csnaot comply with�lte reyucs�
<br /> wiNin rha<«me,he shnll so info�m�he indlvidual,and may have�n addirional l�ve days wichin wRieh�u corn�ly Wi�h che reques�,excludin�5acuniays,
<br /> Sund�ys and legsl holid�ys,
<br /> Sqbd,b. Procedure when dota is aot aecurote ar complete. An Individual may conteu the eccuracy�r comple[eness oF publie or priva�e
<br /> d�n cuncerning himself. To exercise this ngh�.an individual shall no�i[y in wricing�he responsible authoriry describing�hc nature of�he dl�agreemant.
<br /> Tho reaponsible au�horiry shall widiin 3U d�y�eieher: (�)correct[he dan Pound ro be inaccurace or incomplece and aaemp�co nocily pasc recipienu of
<br /> inacaurate or Incompleie daru. Including reeipienis name�by d►e individual;or(b) notiEy�he individual thai he believes�Ile dara to be correc�. Dan
<br /> in dlspuco shxll be disclused artty if�he iruiivid�,al's sra�emen�of di�agreemenc is included wich ihe Aisclosed dara.
<br /> 'Che dctermination of the rasponsible auil,o�iry may be appcaled pursuan�to ihe pro�isians of the odminirtrarive procedure act relacing co
<br /> eont�sted caAes,
<br /> DATA PR�A�X ADV�SORY
<br /> In accordance wich M.S. t3.04, Subd. 2, "Righcs of subjects of data",we would like to inform you that your request
<br /> fqr a permic or license from the City of Orono �r any of its departments may require you to furnish ct�tain private or
<br /> confidential information.
<br /> You are aotificd thac:
<br /> �, The inforrnation you furnish will be used to deeermine your qualification for the permit�r license rcquested.
<br /> 2. You may refuse to supply daca, buc refusal may require �hat the Cicy d�ny che permic or licensr.
<br /> 3, 'The infotmation may be shared with othe�local, state or fcderal agencies to the ertenc necessary co process
<br /> the permit or license.
<br /> 4. If your requested permic or licanse requires Council action to approvc, some information may become
<br /> public.
<br /> 5, You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself.
<br /> 6, Your full name !s required co procoss this applicaeion oc permi�.
<br /> �,�N ,e� I��R�,N IN ��s6�
<br /> M�a►� �:�
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<br /> � ��o� C���N-rY n
<br /> Aaa�=� _rdl� .lJ-�3�(3 �'3 �—�(3�
<br /> � r`'s /JJ Phonc
<br /> Stats 7.ip
<br /> Ciq�
<br /> i understand my rights as staced above.
<br /> Sfgnewre
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