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Apr-09-2003 11 :28am From-CITY OF ORONO +6522484616 T-Z46 P.003/006 F-260 <br /> Ses.13•04 RIG[�T5 OF 5"fJBJECTS OF DATA <br /> Subd. 1. 'X'ype af duta. The nghcs of iudividuat on whom[he dara is seoced or co be swrtd st,a31 he a�sec for�b ia chis section. <br /> Subd.2. Iafarmatton required to 6e�iven mdiridual. An individua!asked to supply privare or co�denoal dara coaceraing himsetf shall <br /> ba infaimcd of: {a)[he purposc and intended use oP ihe reqvesud data wirhin iha coliecdng�rare age�y, paliocal subdivision,os sffi�wide sys�m; <br /> (b)whe�hcr he may�fuse oti is lagally�equired ca auppIy she nquas�ed daea;(c)�y lmowa coqsequeace�rising fmm his supplying or refusing to supply <br /> privutc or confidennal da�;and(d)the ideariry of odur persoRs ar ennnes aurhorized by srare or federnl law so rrecive me 4ara. This requiremenc s6all <br /> na��pp1y whan an individvai is asked�o supply invasugaa�e da�.punuani io secdon 13.82,subdivision 5,io s law en{e�emenc afficer. <br /> The comrnissioner of revenur mav nlace che nori�e rnouired under�his subdivision irt �he individua! income r�x or�raoem�ax rctund <br /> inS[ruc�loRS IRs[cad of on tho90 fOTfns. <br /> 5ubd. 3. Aecess to��ata by mdividual. Upoa reques�to a nspansible au�hunry,an iadividual shaU ba islformed whe[her he is t�e subjecc <br /> of scored dara on individuaIs,ar�d wheEher it is classiCed as public,pnvau vc coafiden�sl. Upon his tUnher requesz, au individasl who is�he subject <br /> of srnred private or public dara on individuals sha!!be shown ihc daw wi�hou�any cha�e ea kim and,-if he desires, ShaU be inlormed of ihe cantenc <br /> and rry�anieg of rhu daw. Af�er an individual has becn shawa che privsc�c dam and informcd of its meaaing,[ha dsA accd not bc d'uelased ro him for <br /> six mon�s thcre$fttr unless a dispute nr ac[ion pursuarn W chis Se�caoa is pendine or addioodal da�a aa cho individual has been collccud or crenred. <br /> 'YTie responsible auihoriry shall pravidc capies oP[he Qrivau or public da�a upon reqaat by ehe individual svbjcc�of ihe datd. 'Y'he rasponsibte auchoriry <br /> may requirc the requesdng perfion co pay the acwaI co�ts o�making,cerdiying,and compiling c[�c copies. <br /> . Thc crsponsible au�horiry shall comply immcdia�eiy, iF oassible,wirh any reques�madc pursaant re rhis svbdivision,or wi�hin five duys of <br /> rhe daw of che reques�,czcluding S�airdays,Sundays and legal hoiidays,if irmnediaco complisnee is no�possible. If ha car�aoc comply wieh�he requese <br /> wirhin diae cim�,he shail so inform ihe individual,and may have an addidonal five dsys wi=h'sn which�a eompiy wi�h che tequesc,cxcluding SanlydAys, <br /> Sun3ays aad fcgal holidays, <br /> Subd.4. Procedure wben data is nac aceurate or cousplete. M individual may cona�c the accutacy or comple[tness oF gubtic or priti�a�e <br /> dan concerning himself. To cxanise�his righx,ati individwU shal!nonfy in wricing rhe respoasibfe auzhariry describing�e nanirc af d�e disagree�eat. <br /> The responsibia auihoriry shall widiin 3D days eirher. (,)corrccc tho dara found to be i�aec�rare or incampler�and atma�pt c0 noety pas�recipicnu oF <br /> inaccurs[e ar ineumpie�e da�a, ineiuding rccipicnrs named by rhe individual;ar(b)ootify rhe individuul thac he believes rhe darx to be correct. Data <br /> in dispuu shaJl he disclosed only if nc�indivi�uai's sa[emen�of disasrecmeni is culudzd wirh the disclosed darz, <br /> Thc dcr�rminadon oi tha rasponsibie au�oriry may be appcalcd pursuanc co die pmvisions oP rhe adciiniscrarive procedure act�lacing w <br /> con�es[cd cfl�s, • � <br /> DA'Y'A PRIVACY AD'VYSO�X <br /> In accordance wizh M.S_ 13.OG., Subd.2, "Righzs of subjects of da[a",we would]ike ta inform you zhat your request <br /> for a permii or license from the Ciry of Orono or any of i�s depanmeats may require yqu �o funaish cenain priv�ce ar <br /> confidential infornia�ion. <br /> You are notifed th�u: <br /> 1. The informazian ydu furnish will be used ro determine your qual�catian for the permit or license requested. <br /> 2, Yau may refuse to supply da�a� but refusal may requirc [ha� the Ciry deny the permit or license. <br /> 3. The infarmation rnay be shared wi�h athar loca�, sta�e or federal agencies �o the extent necessary �o process <br /> the permis or license. ' <br /> 4, If your iequested permit or license requires Council ac�ion to approve, some iufo�mation may become <br /> public. <br /> 5. You have �:enain rights under M.S. 13.0� (availabie upon reques�) to review private data oa yourseli. <br /> 6. Your full name is required to precess rhis application or permi�. <br /> ---�a,�#I' S <br /> �`� 1 g3p Henr��f� Ave. So �� <br /> Address mn , <br /> _ 61Z , g�2 _ 1��L � <br /> Ciry Staca Zip Phuue <br /> T underszand my ri�hu as stated above. � <br /> ����_ � � m3 . <br /> Sigc�atu rr ' <br /> APR-09-2003 11:25AM TEL)+9522494616 ID)KENWOOD REMODELING PAGE:003 R=100% <br />