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03/15/2005 09:21 7634344933 HARMONY HOMES INC PAGE 03 n Jura-2006 00:3389FrtarCITY OF OROS taQ2240�At8 P-r7T P.003/003 F-066 9ea.11 M R143190 Of W=C"OF DATA S"1• Type or daft• The dote of JudivWyal on whom the date le Stowed or a be W"d&M be u tot mu in thb faedoo. red m b.11�lddisld�rL ti Iedlvidltal uloid m seppht private er oosedwttW data aoaeersioj atassit SAaN bo Sabd•Z Iatorsetland* dee ate at the requested gv dot:wiehln tha connoting swan agsoer,peg"aubdWbloe,or saRewMe Wine a;(h) 1lforel>d do U)who gat•oosS a ,.,, asp Imowa tSt?tsc�a+aenee at w*-,,bim%is sooph'lag or nK+i d to supply wfiatber be clay return or,a kgub rcgvlr-1:',u.;Avply dos rrRat. private er eesedatad daft;aed(d)t>•s Wensley of colter peso s ou nadga 2to swam 13J29 bdWOO $,to bw ea Wreement AM` �so Pat epplYwi {aptddttSt y SAW 10 supply InvetttlpGre 4dart,Pot c ht the Sri a at &.(rrANat laegad_aLee. �r Sob L 3. Aeaeea to data by bWlvldooL upon tegaat w a nupoadble�orKY+art 1ndl TI send be lafort.ed.whetltcr be it tla Sabina of otor>d don ate ledlridas�b,sled whetb■r k b de "p`W pdvm or ooaftea UL upon bb tbrtber ttgttat,as isdivost who b the subject or tam cd p�or public dans en Itrdh Um b ensu be Shown tits trate whbc=a"ebwP to bba end,a<he det4ts,lbSq be lobw+eed of doe Men o sad astaolep of Ant duos• * gaud Set bew*awe the ptltata elan aed holism"of kt nouba for daft toad trot be dledond w bba for sit toomaha ebsfeettar lobule a dblPate or w0a pargoam w Ab Sealoe i.p>ndlop or otddldtaal dw oft the t>divldral has bees cogorespa ted le 91111.The t:eposdue s uebeft"pvo*Wo 00p�of the private or publ a data wpm r etiustby the WAlwb ad bjat ofthe date.Tho t•espaeable aeteoAq soar .Ire the re4Metlna Puma ft PEI the ota$el coca at mal"w- fyts*and on 111 doe asplee• The rpltoadbla ue6eelq elan eemph►hotaedLab,If po"W%with Say ngVon uvdc pormaw to tib oubdtvblou,or willin five dtyytettbe am of the rttgaomf,eadadled t 9ettdu>i Sad 14W wmq%If bntoedlaa eompliattce Is trot POONA.Who rrnt�comply wkb Im ergaestwill" rpht Bossu 1M tball so lsfsrm the btdhld%S and ttsay bare oft adolttonal eve days whbin woke to oompb►wl*qts regaest,axslaabtp Sew>WYs+swWsye and legal pstiatos. Sabel,4,peamdon wpn dm Is not cacao Or 0011111110"'Aa 13040141021tatty cause the accuracy or eeotphtteonss of pablk or pelvaa dna oouroe roll bb smlL To etteidam flus ft%as la fuldeal$bell m110 10 wtithtp the neposele notbom dacriblep the nature of tete duversnea The rownsible anebselly dWB WMIN as duo sober. (6)eorreee tet dna bund to be Iu teearm m Dtcontpkce NbW attotept 0 node'past wedltieau Sf sos lo"toror hseompNa dote,htehldbg rmdOkm oaaKd b7 the htdlaldutll or(b)46110the� Oaf wane ho beds•a the daft to hs tnrtSet Dna i4 nuances!bell be db>bsed�!'d ehe YdMdrah olopineat of dle g nment is hudaded whb the dbduW dare Zee doettrteieSttaq of for raponalbht aadtollq NOY be SWAM pdrmeot to the pro house of tae adndnbtl nave ptpeedare net tslatiag to enstedw tatea. pAT PRIVACY ADYYSO,j In accordatlee with MS.13.04,8ubd.2,"Rights of subjects of data",we would like to inform you that your request for a permit or license from the City of Orono or say of its deparlments tray require you to furtlish certain private or confidential information. You are named that: I. The information you burnish will be used to determine your qualifkation for the permit or 6ceaee requested. 2. You OW refuse to supply data,but refusal any require that the city daily the permit or license. I The informatieA any be shared with other local,state or federal agencies to the extent necessary to process the permit or license. 4• U your requested permit or license requires Conned aedon to approve,some information may become public. S. You have certain rights under XS.13.04(available upon request)to review private data an yourself. 6. Your hell name D required to process this applieatioe or permit. B dA UrO- Alen- First Middle Last 3 (s 1u' �• Addrent S-fm- . 760m- /IOU Cid State Zip Phone I understand my rislits as stated above. Signature