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Dec-22-2006 09:27am From-CITY OF ORONO +9522494616 T-127 P.003/003 F-680 <br /> Sc�.13.oa Tt3GHTS O�STJBJECTS OF DATA <br /> SuDd.1• Type uf da[a. The rlgh[s of indivldual�n�+'hum the duss�ls storcd ur to De stored shall 6e t�s set fo�rtb in this sec[ion. <br /> Subd.:. I nCormatiun required[o be given lndividuul. An Individn�l asked tn supply prlvato or conliJrniial data concrrning hlmseli shall be <br /> informed of; {a)th�purpose and incended use of the requesced dacn w�tt�in the cu��scting statc agcn�y,polfc3cal subd;vision,ur statewide sysTe:n;(b) <br /> wt,�ther he may refuse or is ic�ully reyuir�d to supp�y the requcdua data;(c)nny{rnown conscquenee arlsiog irom his supplyfag or refusing to suppl}� <br /> not,'rpply wh ndan iqdi'idu t�iansked tod up !n y in��-usocive aaca pursuant to sretion]3.�ie oubdEdrisiUn S,to aClaw ento cement}p�c qu�remrnt shAll <br /> Thc cu issioner uf rf+'enuc mA lace thc no ice re uircd �nder this S�hdlvision in iht indiv �ia1 Income tuz o rn ertv tax refu <br /> instructi���s insicad Of U�thnse form . <br /> Subd.3. ACCESS to dutv Ly todividual. Upon mquest w a respoosible authoriry,fii�individual ahsn bc infurmed wbethur he is the subjec�o� <br /> stored dat�on individuals,and�vhesher it is classiticd as publiq privafe or Confidrn[ial. L'gon his furthcr requcst,an individval who Is tbe subjrcc o( <br /> stored privatr ur pubUc data on indiyldua�s shAll be shown tlte data w�thuu[aoy chargc tU k�irn and,if he desirc�,ah�l!be fntormed ot the coo[ent and <br /> meaning uf cha�daca. Atter an indiviaual has bccn s1�oN'11 CAC PfIV:ILC daLB BiIU 1(ITOYYYI�'d Pi It5 RI1Y11111�',t�e data necd not bc aisclosed to him[or siz <br /> mun[hs thcrcnfier unless a dispute or action pursuant to this seCt{on is pendii�g�r addition�l d'r[:�on the fadividuu►has betn coUec[ed orcrcflted. The <br /> respunsiDle autfiority shail provide copies of the private or public dutn upun request by�he lndividual eubjrer of ihe data- Tbe rngonsible authoriq�ma� <br /> requfr•e the rcyuesting person to pay tde accual eosts o[making�cenify�n�,and rnmpilinb il,e eopies. <br /> TAe respansible authGcicy shap Comply immcdiately,i(po�b�b�c,lv�Ih any request nlsde pursuant m this subdivlSloD,0�w�tnin tvt daye of the <br /> da[e ot thc reques�,ezc3uding Samrdays,Sundays and legsl h�lidays,lt immcdiAte comp��9nn is noi possi4le.If be tanqot rnmply wiTh the�equastwiihin <br /> thac cime.,he shall so inform the lndividunl,and may nvve an additional Pve days wichin wl�ich�o comply with che requesy ezdudingSamrdnys,Sunda�s <br /> and legal hul;days. <br /> Subd.s. Proeedure wbnn data fs not accurnte or camplete. An individual mfly contestthe accuraey or eomQletenas o[publie or privatedata <br /> toqeernins himself. Ta ezercisc[his Hghy an indtv[dual shull noA�'In„'riting The reS]�onxibie authority descrlbing the aaturc of Lhe diSagYeellunt.7hr <br /> responstble auchoriry shall within 3D days eitber: (o)eorrecc thu anta found to bn inuceurate or incomplece and ac[emp�w notitY paeY reeipien�s of <br /> insccura�e or Incomplccc d�ta,induding reeipien[s aamcd by the IndlviduYl;or @)nocity thc individual�hat he believes thc dvta to be correct. bata in <br /> dispuce shau be disclosed only if[he indtvidual's ssatement of dis�reemenc is included with the disclosrd data. <br /> Tbe dcccrminaiion of iho responslble authoriry may be appu�►ed pursuant to the provisions of ihe adminiscracive proeedure ac�rdatina to <br /> �pntcstcU CaSEs. <br /> 1?ATA PRIVAC'S'ADVISOItl' <br /> In accordance WiLh M.S.13.04,Subd.2,"RSghts of subjects of data",we�vould like to inform you th�t your recjuest <br /> for a pernut or liceuse from the City of Oroao or ana�of its depArtmnents may reqaire you to furnish certain private or <br /> confidential information. <br /> You are notired that: <br /> 1. The intorcnation you fnrnish will be u�ed to determine your qualification for the permit or license reqnested. <br /> 2. You�anay refuse to supply data,but refnsal may require shat the City deny the permit or license. <br /> 3. 'The ir,formation map be shared with other local,state or federal agencies to the extent necessary to process <br /> the permit or license. <br /> 4. Tf yaur reqnested perrnit or license requires Councit action to upprave, some information may become <br /> public. <br /> 5, 1'ou have certain rights under M.S.13.04(available upon request)to re��iew private data on yourse3f. <br /> 6, Yuur full name is rec�uired to process this applicatiou or permit. <br /> -� G1 i ti�- <br /> Firs[ Mltldle �.ast <br /> �J`13ar� �xc�els%� 13�v <br /> Address ''/� ��/s— �',�`z�ZQZ.�v� <br /> tm(dl ,1 �,. liv� 7 / <br /> Ci�, � State Z�p Phont <br /> I understund rights as staced above. <br /> Signaturr <br />