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Jan-31-2002 10:03am From-CITY OF ORONO +9522494616 T-587 P.007/007 F-098 <br /> � <br /> : <br /> ,+ Scc,13.OS RIGHTS OF SUBJECI'S p�'bATA, <br /> Subd. !. Type of data. The righu oP individuaI on wqo�n the data is swred or to be s[ored shall be as set forth in shis sacrion. <br /> Subd.Z. Inforqtution rrquired tu be�ven iud"svidual. Art individual asked[o supply privace or confidcncial dara conec,�ing himsalf <br /> shat]be inlo�r.�vf; �a�rh�pu�s���epdrd use of�hc rcquecccd da[a wirhin nc�cotleccing stace agency,poli�ica!subdivisioa,ar s�atowide <br /> sY��m;(b)wheihen c�may refusc or is lcgaity rzquircd to supply�he requested darr;{c}aqy la�awn consequcnce arising fram his supplyiag or <br /> refusino ro supply privxtc or conPidenual da�;and(d)rht idenriry of oxher persons or endaes authorized by state or frderal!aw�o reccive die d$ca. <br /> This requirzm<nt shafl not apply whcn an individual is askcd �o supp]y inves�igativs darr, pursuan[�o scchon 13.82, Subdivision 5, to a law <br /> cn{oraemenr oPf,ccr. <br /> ���S��jssiolteY nP rcvmue mav nlace•hP nnpce reeu�:�rd ihis cuhdivisi0n in the inAivedu�tl ineome rax a�brApercy rax rcfund <br /> incrn�crions j�.ctca4 of on tfinee(orms, <br /> Subd. 3. Aecess to data by tndividual. Upon reques�ro a responsiblc suthoriry,�n individual shall be informcd whoihcr he�s rha <br /> subjecc oF srored dAia on individuats,and whenc�r ic is ciassificd as pub�ic,priva�e or canfidenci�l. Upon his furdtar r�quest,an individua!who <br /> is rhe subjec[oPsrnred priva[a or public data on individuals shall bc snown�hc data wirhout any charge co him�nd, if he Aosires,Shall be informed <br /> of rhe conrent and mzaning of shac da�s. .4fur an individua!has bcen shown thc priva�e eata and informed oP iis meaning,the d$ta need noc be <br /> disc[ostd co him for six monThs[heceaher unleSs a dispute or acrion pursuan�ro rhis sccdon is pendir�g or addirional a$ra on chc indiviclual has been <br /> co!lcc�ed or crearcd. "Ihe responsibte authoriry ahaq provida copies oF d�priva�e or public d3c�upon requesc by the individu�!subjecc of the da�a. <br /> 7hc responsibl�uuthoriry may rcquirz thc reque�cing person tv pay zhe aca.,at cosu of making,eercifying,and compiling iha eopies. <br /> Tht responsibla auihoriry sfnll cotnply immediaaiy,if Po.,sible.wi��qy requase made pursuant w this svbdivision.or within five days <br /> oP rhe dscc of�he rcquesc,cxcluaing 5aardays, 5undays aad Iegal l�olidays,iF immadiace compliance is nvt possibla, IP he cannoc eamply widl <br /> thc rcqLesi wirhin�ha�rirrse,hc shatl so inform�nc individual,and may havc an addi�ionai five days wiihin which to eomply wi�h�he rac�cnst, <br /> excludin�r Sawrdays,Sunc►ays and icgAl holidays. <br /> Subd.4. Procedure whea data is not aeeurate or complete. An individual may cantes<<he accuraey or comptcceness of puhEic or <br /> privace dar�eonccrning hi�elf. To axcreise[his righ[,an individuai shait no�ify in wririrLq che raspansible authoriry$cscribing the•nacurc of tha <br /> disaereerr.en[. 7hc responsiblr aurhoriry st�a)1 within 34 d�ys einc��: (a)eoncec ehe daa found�o be inaccura�e or incomplcce snd attcmpc�o aocify <br /> past r:�isien�s of inaccura[c nr incomplere data,inctuding recipiencs named by tpc individual;or(b)nocify rhe individusl�hac he belicves rhe da�a <br /> co bz corrcct. Dara in dispuie Sha11 be disNased only if thc individuai's sncement of disagrccmcn[is inefuded wi�h the disclosed dara. <br /> The decerminaaon of rhe responsible auchoriry may be appo:�led pursuanc co tho provi�ions of rha adminiscrative proerdure aee relaci�q <br /> to conszsrzd cases. <br /> I�TA PRY'�'A�Y A�SOR'Y' <br /> In accordance wiih M.S. 13.04, Subd. 2, "Right:� of subjects af data", we would like to inform you zhat your <br /> requesc for a permi�or license from she Gisy of Orono or any of its departments may require you to furnish certain <br /> priva�e or cor1Fdential izlforma[i0n. <br /> You are notified chat: <br /> 1. The informa[ion you furnish will be us4d to deteruiine your qualification for tize permit or license <br /> requested. <br /> '-. Xou may refuse �q supply d�ta, but refu:;al may reyuire that the Ciry deny [bt permit or 3icense. <br /> �. The informatiotc may be shared with ot?:er Iocal, stale or federal xgencies ta the extent necessary to <br /> pracess the permit or ticense_ <br /> 4. If your reques�ed permi�oz license requir�:s Councii aeiipn to approve, some infarmation msy become <br /> public. <br /> 3. You have eertain rights under M.S. 13_Q4 (avaiiable upon request) ta review private daia on yaurseif. <br /> 6• Your full name is required �o proeess this application or permit. <br /> Firs� hfiddlc i.asi <br /> Address <br /> Ciry State 2iP Phorx <br /> r undtrstand my rights as stated above. <br /> Signacure <br /> � <br /> 6 <br />