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Sep-�6-2001 08:llam From-CITY OF ORONO +9522494616 T-770 P.002/002 F-838 . S�ai3.04 RIGHTS OF StJB.�C'Y'S OF D�T�, Subd. 1. T'ype oP daza. The righ�s of individuai oa whom�be dara is s�ored or�o bc scorrd shall be ss set fozTh in this secdon, Subd.Z. Infoizuacion reqUired to be given iudiridual. An individual asked ro supply private or confidenrial dara concerning himself shsIl be informcd of: (a) tha purpose and inr�ndcd usc of che requesud da�within r�e coilccring 5rare a.gency,poliocsl subdivision>or scaccwide system; (b)wF.e�hen c�may rfusc or is legally required io suppty thc roquessed Q.�w;(c)sny known conscqucn�e arising from his suppiying or rcfusing ca svgply privan ar confider.fial dara;and{d)tk;c idenaty af ocher pzrsons or cnAdc�authorizcd by e�ate or fede�l law ro rtccivc rhe daca_ 'This requiremen�stiaIi no�app}y wncn an individual is asked to supply invesri�adve dat1, peruan�:a se:¢on 13.83, subdivision S, co a law enfo�cment oPficer. Thc cammissioner of rever.ue mav �facc :he nonce reauirre undar[�is sLbdivision in the individual_incomc caz or propertY cax tefund inscructions i.nstead of on chnse iorms. Subd. 3, Access�o data by indiridua[. 'Upon requesc�o a rr;pansible aurhariry,an individusl shaE]bc inforrncd whather he is 'uc sabjcc� of stored dsrs on individuals, and wheiher i�is cIassificd as publi:, pn�a�e or eoiifidenu�l. Upon tua furher requcsz, an iudividua] who u;he subjecc of scored privas� or pub[ic dara on individuals shall be shown che duta N�rhouc aiiy charge�o him and, if he desires, shall be infotmcd of rhe con�er.: and mcaning of chac dsrs. Afur an individu:il has been shown iE:e privf,�e data and'uuormzd of i�s meazing, sha dara need not be discloscd co him for yiz monshs ihcscafrcr unlcss a dispuie or acrion pur�unnt co �his sccdon i�pnnding or addidonal da�a on zhc indi�idus!ha�bccn eollec�ed or c�ar�d. The responsihle aurhoriry shall provide copies ot rhe priva�e or public dats apon requesi by�':c iadividua!subjccs of nc�daca. 'I'hc respQnsibte aurhoriry inay requize chc rcque�vng person to pay the aen�al cosrs of makin�, c.;rrifying,and eompiling the copics, . "I�e responsi5ie authoriry sha11 comply immadiately, if possi�la, wich any rcquase made pursuant rv ihis suhdivision, or wirhin ftvc days of che dare of shc crquzst,excluding Saturdays,Sundays and 1c;a!haiidays,if ir.unndiace compliance is noc pessible. If he ca.Zaot comp!y winc�he request within tl:at rime,he sha11 so inform rhe ir�dividuxl,and m3y havc sn add:uona(fivc dsys within which w compty wich thz reques�,exc!�ding Sacurdays, Sundays and tcgal holidays, Subd.a. Proeedure when data is aot accurate or completc, An individuat may con�csi che accuracy or compteuness of pubiic or pm�acc da�a conceming himsetf. To exercise this righc,an individual shstf aocify in wricin;w�responsible authonry describing the nan:re of thc disagreemeat. The respor.sibic aushoriry shAA wirhin 50 days ci;.Zcr: (a}correc:zhc da�s found iA be inaccuracc or incompie�e snd aacmpt to nodfy pasc recipicr.ss of inaccuraze or incomg3ete da�s, inctuding reeipienu na�cd by ehe individual; ar(b)n��ify[he indi�idual tha�he believes 4`�e d��.w bc eocre:t. Dzc� in dispucc shall be disclosed or�iy if ihc individuul's srstemcni of disag,Gcment is includcd wish�he disolos<d dara. The de�erminnrion of the responsible authoriry may bc spptaled p�rsaaac to cha pro�isions of�he adminiscraave p�ceQure act relacng co concesKd cascs. D�,TA pRrV ACY AD�'TSORY In accordance with M,S. 13.04, Subd. 2, "Rights of stibjects of data", we would like co inform you that your reqeest for a pernZic or license from �he Ciry of Orono or any oi its departments may require yon to fumish cenain private or confidential information. You are notified that: 1, The information you furnish will be used to cjetermiae your qualifcation for the permit or license rcquested. 2. You may refuse �o supply data, but refusal may require that the Ciry deny the permit or license. 3, T'tie information may be shared with other lc�cal, scace or federal agencies to the extent neeessary to process the permit or liccnse. 4. If your requested permit or license requiie�; Cotuicii action to agprove, some informatioa may become pubiic. 5. 'You have certzin rights under '.VI.S. 13.04 {available upon re�uest) to review private data on yourself_ 6. Your full name is required to praczss this applicacion or permit. � � d �1.� �• _ � �/'�v��/ Firs[ Vliddte LSs� Z.SSG F+�� _ Address j� �� •��I� "�]��l�� r�na S �, ._ � � Ciry S�« Zip Phone siand my rights as s�ace above_ � I Sign c �