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002 11:18am From-CITY OF ORONO +9522494616 T-771 P.003/003 F-535 <br /> See.13.04 Rtcros OF SUBJECTS OF DATA <br /> Sod. 1. Type of data. The dgbts of individual on whom die dam is stated of to be stored shalt be as sa foctlt in this section. <br /> Subd.Z. b"Mation rM dred to be given hWlVMuat. An ioXw dual&"to m"ly pcivaw or confdendai data eonce mkg himself dmu <br /> /be bdormOd ofd (a)the purpose and handed we of the requested data within dtc collating state agency,political subdivision.or smewids system: <br /> (b)whedter he stay refuse ar is legally n4"ited m supply the tegtresnd d.ua:(c)arty lmown r�sequeace arising from his arppiying or renllnsietg m supply <br /> pdvaam or confideaeal dAW and(d)the idenmy of other persons or eudd as astthorbtd by sum ar fedcsal law m receive dee data. This rt quh=cut shall <br /> not apply aben an individual is asked to supply investigative data,pursuant to sccdon 13.62.subdivision S,to a law enforcemrent offiicer.' <br /> ':?•a commi ' net of raveswe tttav mace rhe rtodce rtottitcd under tills sobdi<�ion art dee individual' tax or arooetsv ax refund <br /> iosttuedons instead of on thaw fo nt. <br /> Subd.3. Access to data by indiidual. Upon regoea to a responsible anthoriry,an individual shall be ipformed wteeel�r be is rho sadtjtxc <br /> of stated data on individuals.and wlxmer it is cl"Med as public,private or coofideatui. upon bis Audter request,an individual who is the subject <br /> of stored private or public data on individuals stall be shown the dam wwwor airy charge to him":if he desires,shall be informed of Ott c ata= <br /> and mm tag of that dam. Aftar an individual bas been shown the Privua dam and in6otmod of its atesaiog,the data need not be disclosed to biro for <br /> six months dmeaft unless a dispute or action pursuant m this sued=is pending or additional data on the iadireduat bas been colkcmd or cre!d- <br /> Tbe respozible autbority shalt provide copies of the private or public dam upon Must,by dee individual subject of the dam. 'rho responsible authority <br /> may require the Mqueldng pow to pay die actual costs of Malting.c;tdfyia`,and comms&a txtpies. <br /> The reaponoible=&O <br /> ft shall comply iutmediarely,if possible,wi&airy tagmx made p==to this subdivision,or wtrhin five days of <br /> the dna of the toques.c>vebrd S■nitdays,Sundays and holidays,if ymaediacrcoa>ldiance is roc possible. 1f ba eanooc comply with the request <br /> within drat time,he shall so btfomo dee i xkviduar,and nay lave an additional em days wk*which to empty with tha request,exciDdmg SaattdaYs. <br /> Sundays and legal holidays. <br /> Subd.4. Procedure whe12 data is not accnrare or cnmplett. Aa individual may contest dtt:accuraq or cou ptmims of public or ptivatc <br /> data concerning himself- To vmuiae this right.an individual shall tsoWy in writing dtc tesponsibk audtotiay descti'bing dte taultre of the disagreemem <br /> Tbc tegoauble authority sW 1 wtthia 30 days chher. (a)correct the dare found w be ioac:urase ar ineotnplM add atumpcto notify past reeiPienzs of <br /> ivaccumm or incomplete dare.incbuft recipients named by dee individual;or(b)no*die individual that he believes die data to be correct. Data <br /> is disputa shat be disclosed only if the individual's su&x u of disagrectocut is hKIWe4 with the disclosed data. <br /> Tho determination of rbe tespomible aattoft may be appr*led Pursuant to the provisions of the administrative procedure sir mhuipg m <br /> contested cases. <br /> DATA PR 'ACY ADVISORY <br /> In accords= with M.S. 13.04,Subd.2,"Rights of subjects of data%we would like to inform you that your request <br /> for a permit or license from the City of Orono Or any of its departments may require you to furnish certain privze or <br /> confidential information. <br /> You are notified than <br /> 1. The information you furnish will be used to determine your qualification for the pertain or license requested. <br /> 2. You may refuse to supply data, but refusal may require that the City deny the permit or license. <br /> 3. The information may be shared with other local,stare or federal agencies 10 the extent necessary to proms <br /> the permit or license. <br /> 4. If your requested permit or license requires Council action to approve, some informadon may become <br /> public. <br /> S, You have certain rights under M.S. 13.04(available upon request) to review private dans on yourself. <br /> b. Your fall name is required to process this application or permit. / <br /> First `' ik s� rim <br /> - tq <br /> Q� . <br /> (.c sus S 3 L <br /> Char State Zip Pbone <br /> I understand ray rights as stated above. <br /> Sigoaatrc . <br />