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T� �F aR9�0 � 5�24��0510 OG�24/96 14:00 �1 :43/03 N�:52� <br /> . � :. <br /> S+cc.13.04 1tIG�iT$OF SUH,iEC'I�S OF DA'f'.t <br /> Subd. 1. Typt of alata. 2Ae rlyd�s of indlvidud on�rhom eha daa Is smred or ro be smcrd shall be as see fonh in this seedan. <br /> Subd.�. Inlora�atlon roq�rsd po be gtvsn indf�►idu71._M Individual asked ro supply privste or oonfidenu�l dota cancarnlhg�lmaelf ahall <br /> be Ir�lonned of: (.)tlle purpose and inunded use of the�equescd!dtm withia the wlfsedng Btace agency,polldcal subdi�ision,or snrowide syseem: <br /> (b}wluther h�may reflise ot is legally required w supply rhe roqu�ased daa:{c)any knoa+n�onsequeaee arising from hls supplyfng or rolUsing ro supply <br /> priva�a or copflden[i�t dsa;and(d)�he idenriry o!od+e�person�or endries aud�orized by sum or tederal law u�re�eive rhe data. 1'6Lt requiremenc 5ha11 <br /> noc appiy whea an individual ia esked eo aupply tn�esdgarive daa, punuan�co cecdon 13.62,subdivision S,to s I�w enfortemen�ol�icer. <br /> �Q,c mi issigna QP ro�enue ma� alace che noc�c= r�auirsd under this subdi�isiv in �fi� individuai incnme rax or oroos�v mx�n�ind <br /> -_ , lnc��ion�t i{�s ad u�on rhoso fortns, " <br /> SuDd,3. Aeeees to data by G�dlvidu�l. Upon rcquest to a rcspansible authanry,an indi�idual shali be informed vvhather 6e le the s�tbJeec <br /> ot etarod dua on individuais,and whecher ic is elassified a9 public, ppvace ar sonPldea[ial. Upon fus}I�rther rcquest,an individual who i��he subjtct <br /> of s[ored pri�sce or public daw en individuals shall be shmrn�he dars wirhoue any charae ur him and;if he deaires,sheil be infonned of the wntent <br /> rnd meaning of diat data. Aher an irnli�idua!ha9 heen shown ohe p�i�ew dnra end iatom�ed of in�esning,the dao aeed noc be diulosed w him for <br /> ds emnrhs theresFur unle:s a dispute or�ction pursuan[m this seedon is pendin�or addi�io��l dua un ihe individual 11as been e�ilecced or creatLd. <br /> Ti�e rsapu�eib{e authpriry chail provide copies af rhe privare or pubiic da�upon rcquesc Ey�he individua!subjec�of�e dara. '!?�e responsible aa�horiry <br /> may requiro che roquearin�person ro pay�,e aen,al cosu of making,csrtifying.and eompilia8 rhe eopies. <br /> 'Tbe nesponsible suth�rity shall comply immediately, if pussible.aich any requesc made pucauant ro fiis subdivision,or wi�hin fi�a day�of <br /> che date of qu requea�,exetudinQ Satutdays.Sundays and lcgal holldays,if immedlaee complisnce is not po9siblc. If'he caraio�compiy wi�h d�e roques� <br /> wlth�n�hu clmo,he�hall au inPorm che indivfdual,and may ha�e an addirion�l Five dsys wid�in which ro comply�i�h she request,excludlt►g Saairdays. <br /> S1imleye nnd legpl holMaye. <br /> Subd.4, �oeedu�e wh�n dnta is not occurote or enmpiete. An indi�idual m�y conuss��accuracy or complercnos�of pubiic or privrue <br /> deu rancernrng bimself. To exarcise�Ais right.an indi'vidvel shal)noaf�in wridnQ�+e ros�wnsible suehurity�euribing d�e neeuro of�he diadgreemcnc. <br /> 1'he roApon�lble Authoriry sltell withit�30 days either: (a)cotrecc the data found eo be inaccucxte or incorr►ple[e and atrempt to nodfy paie recipiencs eE <br /> iaaeeucue o�incaroQlete dpa, Including recipiencs namcd by d�e individual;or(b)nodfy�hc individual ths�he belleves the dara co be cnRece. Data <br /> ip d�pute ihsll be discloaed only if the inclividusl's su�ement of disaQaemen�is includad with the di9closed dara. <br /> 9'he deromunnrion o►�he rrsponsible.u�tioriry may be appealed pursuani to ths pm�isionc of Tlte adminisuarive procedure act rclacine� <br /> concested oases. , <br /> ' p TA P�tIVACY ADVI$ORY <br /> in accordaace with[4i.S. 13.04, Subd.2, "Righcs of su6Jects of da�a", we would like to inform you chac your sequesc <br /> for a pern�it or license from the City of Orono or any of its departments may require you to furnish certain private or <br /> confidentlal information. <br /> You are noti6ed thar. <br /> 1. The infocmetian you furnish will be used to determine your qualification for the permic orlicense requested. <br /> 2. Yuu may refuse co suppiy daca. buc refusa�l may require thac the City deny the permit or license. <br /> 3. The information may be shared with othCr loeal, state or federal agencies to the eAtent nccGssnry to process <br /> the psrmi[ or license. <br /> � 4. . if youY requcatcd permit or license requires Councit action [o approve, some infarmation may becomc <br /> ' public. <br /> 5. You have cercain righ�s under M,S. 13.04 (available upon request) to review private data oa yourself. <br /> 6,� Ynur futl name is requirod to process this applieation or permic. <br /> ' _ � �,�� <br /> First Midd1�- I.a:t. <br /> . 1, .� _�, � .�� � � <br /> . � � � �e- � � ���- ���". <br /> � <br /> ��y Som Zip Phone <br /> ' d•u�derstand any dght� ' aced above. _ <br /> Si�tu,Nne <br /> Dn... . ..� � T'. /� AI 1 I/�T7f T. . 1 /P� n w . . .ww�• <br />