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NOV-18-2010 02:46 FROM:TREBILFOUNDATION SYS 3205938720 TO:19522494616 P.4/4 <br /> 3ac1a.W R1OtrMOR5UndWl'1lOFDATA <br /> Subd.1. Type of des. 7be riehb of individual on whom the dale is eland or to be stored doll be a sct form in this radian. <br /> 5ubL a hdosssstknt wquitod to be givw ivl"nr�Ao sndivids.l admdlo wPP1Y P O e.oenfidaalid dna aaaoanimg hvrsalrsba0 be <br /> iofeaoed nr(a)the pr<pmo and Wooded rseof Iba regYmtod data within thm collecting state Marcy.political subdivision,or s dowido aystoor,(b) <br /> wlaUarbe may-dine ar s legally mplirod tasapply the tequatad data;(o)arty Itaowa poaaagtrespce arising fano his supplying w refusing M supply <br /> piv000reoeGdmgaldateand(d)Moidmlityofotbcrptaaasoreatingadbamodbysmarradadbwtotecehvamodm71ii tmqubcon.rAshoa <br /> amt apply when■e hrWvtdwl Is"cad to apply love uplive data,pwaunt to suction 13.02,subdivisiat S.to a law cafaarnmu 611100F. <br /> The cumisginigner of ro MU elm 64 Owns�ivad a_ lit as..I.d:yi■im in me individual inoome tae or Renate in tduad <br /> iemumd"M iatoad a[-e d ow fame. <br /> Sobel.3.Aoova to dela by individeaL Upon sequel to a r m"Wo authority.as individual doll be idamodwladtwbo is thio suhjcct of <br /> etaad dola an individuab4 sad whdher it is cls W led a public,pihw or camfidetial Upas bis(blow-equal an i-tdvidaul who is ehoWlIjod or <br /> shmod privsle or public data on individuals shall be Wave mo dela tritbma say dwV to him and,if he doahns.shall oa inranned of tbo coma-and <br /> nvooiae of that data. Allam itdividnl tea bout shown the"laden sal infonood or hu meaning.the data mood not be d'vdmed to him far six <br /> sewdhs tbwomflarunlw a dispule or sclion pamusnt to Ibis■ectiea is posdimg or additional data on me imr(vidmal bas hem oollaclad or acs"'rhe <br /> mspatuiblo astho-ily shall provide topics of me privue or public dw upon-spot bithe imdividtul sabjw of thio data.Tho responsible sWhorky <br /> may require da"n"ling lance Ia pay the sent cogs of msk4 cas"ying,and aompilins an oupias. <br /> Marcel ill,archon'tysbaticanplyinmodiably.Wlma&,wilhbay roquolmdepaawnllothis subdivision,ur within Cryodaysor <br /> Ow datourduo roqumyexclndims Swtdays.Snepdsya m d loll belidays.ifimurpedidsoomplistseo n ndpossibls.ICheesmwd araplywim 1ha requsN <br /> within thiel fine.hn:dug so inl'erm the individual,and"have me addkkoW Gvedays within which to comply with 1ht ntt(nealaotelullitg 5nn-d.ys. <br /> Sundays and Weal holidays. <br /> Svbd.a.nhumdumwhmdstaoaolmwmmooroomplda Aa odividualarroanlapgwaaaor uraompbtonwofpu64eorprivModsa <br /> ouuomntiogbim&dC1'mgsgmisemsrirblmjA%"wltd0nodrynwuoormodinew I.The <br /> eeaporlsible awha ty dug willin 30 days a0w.. (a)call t this data farad b be kwcuedo or' and attempt to notify pat tecipiaas of <br /> imacamau or sroomplea dab,including adpiara anacd by Iia hmilvidast.or(b)mthly the mdwWoat"he bdiovo mo data to bo oorrooL Dale en <br /> disputedullbodisclosedonlyirUraidivWkwhobftmmlordimg- wwM66c)a od.ridsdwd'scbseddsla. <br /> Tho datmmiaYhom oClhe tesponanble ssdbtnity wy�>��pneusM to the pvviainoa of ane ndminshalivo p�ooadu-e ad relating W <br /> ctalcodc+l as. <br /> DUANVACY ADV_ISORar <br /> In accordance with M.S.13.04,SUN.2,"Rights of subjects of dela",We would like to inform you that your wquost <br /> fur a 1ximit or tic coo Fran the City of Orono or any of its departments may roquire you to furnish certain privhle or <br /> confidential information. <br /> You are notified that. <br /> 1. The information you furnish will be used to determine your quulirmalion for the permit or license <br /> rraluested. <br /> 2. You may refute to supply data.but refusal may require Oat the City deny the permit or license. <br /> 3. The information may be shared with o0w local.onto or federal agencics to the extent-necessary to <br /> prones ft permit or license. <br /> 4. 1f your requested permit or license requires Council action to approve,some:information may become <br /> public.. <br /> S. You have certain rights ander MS- 13.04(available upon request)to review private data an yourself. <br /> 6. Yaw full name is rcquind to process this application or permil- <br /> Fwm h11idAM loon <br /> Addrm — <br /> _ f N N 55 3 Ste, _ 3 O --m3 <br /> city State Zip 11bow <br /> I understand my rights as stated above <br /> v�U <br /> ffihRrndura <br /> Resat Form 32 <br />