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11/08/2000 14:04 FAX f�0� <br /> 5cc.13•u1 R1Gti'CS OF SUBJF,C:TS OF D:\1'� <br /> 5���• �. TV}�OP��3- T�1C nghts �f indrvidual nn Whom rhe da�a iS S�nred ur�o bt Scnre�511a�1 be as Se�Fonh in�h�s seeuo0. <br /> SubJ.?. Lnforo��tian required�o be�ivea individual. ,an uidividu:ll asked m supplY privale or�onfidcnoal dala concertsing himseL(shall <br /> bc inForafed oE: (n) �h�P��Pose and ii�cended u5c of�he rsquestal dam wi�hin�e colle�ting�tale�gency, polidcal subdivision.ot s�te�ide.rystem: <br /> (b)whelhec he may rcfiise oT iS legslly required lo SuPPIY��requesled data:(c)any known consequeuce arising from his suppiying o�reEusing�o SupplY <br /> privale o�coniitleilliaf dal�;nnd(cl)thc iden[iry of alhar p�Rosu u«nolies surhorizcd by s��e o�federal law�n rccei��e rhe dala. Thu requlrement s6all <br /> nuC�pply When 3n individual is a5kc� to 5upply� i1l�esoeaCi�e da�, pursuan[[o secuon 13.83, sub�livision 5, fo a lau+ enfor�emen�o�cer, <br /> Tltc comRus���ner c�f re��enu� mav plaCc �he nu(iCc r:ovir�d unJeY �his SUbdiviSiun �n thC Indrviduol inrome r3x or Of�Pem Wx rcfund <br /> jnswCuons inst2ld �t ou thnse lu�m�. <br /> 5ubd• 3- Ac�e.ss lo da�a b1�inJ���d��• Up�in requrs�rn a re�p�insible�u�huriry,an individual Sh�ll be inFormed whcther lte IS the SubjccT <br /> OF stured da�a on indi�i�U�15.an�whcrher il ls clsssiCicJ as publiC. pnvate o�confidcnoal. Upon Liis funhet requesl.an individusl u+ho is�he subject <br /> oC Storcd pnvaze or public dala on mditi idUals shall be shown the dala W¢haul nny ch�rge co him and:if he desires, shall be infarmed of�he con�ent <br /> and meaning uF rha�data, AFter�n individual has bzell 5ho�++n tl�c pnv��e da�a aild inlonned ol i[S meanulg. me da�nced n0L be disclosed ro hirtl for <br /> 5» p�onth5 [hereaftcY unless a di5putd o�acnon pUrSuan�lo Th�s seCtion is pdnding Of adclilional datl on �hd indiv�dual has been e0��ecte�or crealed, <br /> The rCsponsible aU�arity sh111 provide copie5 ot thd Ntiva�e or puhhc d�u:+upon lequest by�he u�dividu;il suh�ect of�e dala. The responsible auChonr.y <br /> may �equire �hc reyues��ng pC�son Lo p1y �he aCN�I costs of�ku�g- �erulylDg. dnd compiling che Copses. <br /> 1'he tet�,onsiblc authonry shall cnmplY i[11�1cdia(ely. if puS5lble, with 3ny�equest m�de pursu3n�to thi5 subd�vlsion,or wlrhin five dsys of <br /> the d�ce of ll�e�equesl.exclu�in,y,Saturd�ys.Sund�ys and le?sl holid�Ys.�f immedi�Ie compliance u i1o�possible. If htl�nnot comply wilh�he reques� <br /> wj�hin[haL time.he Shall So�nfonll�he�ndivldual,�Lld mav li�ive an a�dinonal flve days wi�hin which lo cqmply �++I�h�he requcs�,eaCluding SBNrdays. <br /> Sundays and lcgal h�lid�ys <br /> Suhd.�. ProceJuce when d�ta u nn��ccur,l�e or cuulplctc. An inJiyidual ulay conle5��e aCCur3�y ur completepcss of public ur p[i�ale <br /> data Concernin$himszlF• Tu exerns�d��s neh�_an individ�»I shall n�n'ty �n wnung Ihe resp0��sible au�onn�rsenbtng the na�ure of�he dis�greemeu[- <br /> 1'he responsible�u�honty Sh31I widlin�U�I1y�5 ei�hcr: (a)cnrre��rhe dara found tn be I�l�ecurdle or in�uitlple[e and aaemp�Io nodfy paST re�iplenu of <br /> ina�CU�a[e o[incomplese dak1. includN4 recipien�s namd�l hy tha Ind��tdu�l; or(b)nouFy �he individusl lh�L he believes rhe da��o be correc[. Da� <br /> in Aispu�e shall be disclused only if Lhe i,idividual'S S��emenf oF d�suereerneill�5 included wi(h �e diSC�osed cla��• <br /> The delzrtninati0n of dlz respui�siblc auQ�oriry muy he app��lcd puisuant Iu [he provi�ion�of�he adminisrrdtive �ro:.edure act relanng lo <br /> con�cstcd casa5 <br /> na�r� Pxivac�� �.vvYsc�x� <br /> [u accordan�e wl�h h1.S. 13.04. Siihd.2, "Ri�h[s of'subjeccs �f data", wz woulQ l'tke to ulformyou th3c your[equzs[ <br /> Cor a pernnit or license Crom �he City of Orono or ��y oC i�s dcpartmcn�s may require yau io furnish ceRain private or <br /> cnnfiden[ial inforrna[ion. <br /> You are no�itied �hat: <br /> 1, T1�z informatio��you hirnish will he used[o detcrmine yuur qualiFic�tion for thz permi�or license requested. <br /> 2. You may refuse �o su�ply cia[a, bu� cefils�l u�ay requirc diat thc (:iry deny �he permi� or liccnse- <br /> 3. The informa[ion may hc shared wi[h a[}�er local, sca�c: or fedcral a�cncies �o[he cx[en�neccssary �o p.ocess <br /> �hz �Frmit or lic�n52. <br /> q, If your cequested pzimi� ur licznse r�quires C:ouncil �c�ion to appruve, some information may become <br /> puUl'lc. <br /> 5. Y�u have cenain ri`f�[s untlz[ M.S. 13.U-1 (av;iil�blc �pon r�quzs�) �o [evic�� pnvate data on yourself. <br /> 6, Yu�i� Full naisle is required to proccss this applica�ion or permi�. <br /> � <br /> ���� — ) �C E'. ' . �� '` \ � <br /> p1 iddl L'':� <br /> Fits� — <br /> �$-���'�'�� ' <br /> Address � \ 1�1�� ����V� � J �- � � <br /> C Phone <br /> •_� � �' �a •� S�ta ZiP <br /> Ciry <br /> I und2rs�and my riqhrs as sta�cd zhove, ` <br /> �_--.-'-__ _ _ ' � <br /> � <br /> Sign�in�re <br />