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TY OF ORONO � 6124730510 09/Z4/96 1�.0� � 003/03 N0:522 <br /> . , . ' <br /> . . <br /> 3+tc.13.04�1G1�'i'��F SUBJEC'IfS OF DA1f'A <br /> Subd. i. '8yp¢cf dota. `I'he elBhts af endlvidu.I oo whom the da�Is scored or tv be sto�td 9hall be ti set fonh In d�is seeacn. <br /> Subd.3. I�onaatlun roqudred to be�Iv�n Indi�idual. An tadividual nsicod�o suppiy privsce or oonfidend�l daa cancerning himaeifahall <br /> be Infonned oft (8)tho pu�pose and intended use aP the vequessed dora whhiu the colleerin6 Ata�e agenoy,polldcal aubdivisian,ar snte�vide system: <br /> (b)whether b.may raPl�se ot i!legally required cn supply the eaquessed dau:{c)�y kaoum eonuqueaee ariaing from his supplying or reA�sing te supply <br /> privaca or coatldencL�!dsa;and(d)�he idenrih o!odie�persons or enddes aurhorized by su�e or tederal IAw 4n r�e�ive�he dara. Thf�requiremenc shull <br /> a�ot apply when an inrliriduet is esked eo supply fa�esrig4dve daa.pursuant to eeadon 13.�2,subdivision 3.eo�law eaforcemen�ofPfcer. <br /> ,. � <br /> '�p,gup�p,ti�,sig �enue mad alace rhe�oc�ce reauirad under r�is subdi�isiR in th� indfvidu�l income tax or orooem r�z�e�ei�;rid <br /> _ , jn�uucdona�q ac�u�on�hoeo�Qrm�. „ <br /> Subd.3. Are:as¢e data by 6ndlvida�l. Upnn rcques�to a rcsponsible authanry.en indi�fdual shall be[nfoimed whathcr he la the subJeet <br /> o[atorsd dru on iudividuals.aiad whediar ic is elassified s�pubtic,ppvue or conlldenrial, Upon 6is tl�rrtier rcques[,an individual who is�he subjact <br /> of owTed prira�e oc publiC d9�e oe1 illdIvidutl!sht!!be 911o�m the dals wi�lfou[sny Chi[�e to him W1d;if he desiraa,shetl be infotmed of the content <br /> aM ts+eaning of�ae.dam. Aher�n imiividull has bean shown ohe pt{vtu�ra and[afomied of its meaning,the dace nend twtbe diulos�d to him for <br /> a1x�ond►s theraaher unlesi a dispute or 9cdon pursuan�m �his seceibn e�pendin�or addidonsl�a on the individual htt been oullecad or ersaCcd. <br /> 7Ue csspunsible�uthpriry choll proVide copiea of rhe pmrim or public dara upon requesc by�ha individua!subjeoc of�e dua. The Tesponsible autboriry <br /> may requiro tho requeBNn�pmrson ro pay�he aetuai cosrs of making,csrtifyin�.end eompHing ebe Copi�e. <br /> 'Ibe responaible au�horiry.shall comply immediuely,if possible,wi�h anr requesc muto pursuant w�is subdivision,or wi�hin five day�of <br /> d�s Aafe of ehe requeac,exctuding Santtdays.Sundays and teg�!holldays,if immedtace comptlance i�noi possibte. INhe cannot somply wich d,o requesc . <br /> within�hac�tma,ho ahal)aa inform eha Individusl,and may ba�e at►adrllrional five days wld�in which m comply�hh the eequest,OKCIUdIQg S4Qlidey3. <br /> 5bndtys and legpl holldaye. <br /> Subd.4. Roeeduee wh�d da�a e�net acewata or eomplete. An indfvidunl m�y contss�the accu[say or complerenos�of publ[c or privrce <br /> daa aoneorn�n`birtwelP. To exercise ihis right,sn iadi'viduel shall noul�in wtieing the respunsible�urhodry desctiblog Q�$tu►mre of tho dfugroemcnc. . <br /> T'he ivapenplble�uthoriry shell wirhin 30 days eieher. (a)correcc tke data found�o be inaccur�,te or inc�mpk�e and aRompt to noafy p�c raeiplenes of <br /> in�aucate or inc:amplete dpra, Ihcludin�recipients named by d�e individual;or(b)noafyr the indivirivat that ho believes tha dara co bo oors+eee. Data <br /> ip d�pu�e�hall be diulosad a�ty if the inefividu�l's snamen[of dlsaqreement is includu!with�ha di9cloud dara. ' <br /> 'i'he dotermination of ihe rosponsible autlioriry may bo appealed pursvdn►to vhe provisionc oF dte adm►ni:risdve praceduro act rela�inB� <br /> aon�esred caees. , <br /> . ' DATA P�tYVACY ADVI¢QRY - " - <br /> In accordance with M.S. 13.04,Subd.2, "Aighcs of suliJects of daza", we would like to infocm you that your request <br /> for a permit or licenso from che City of Orono or any of its d�partments may requlra you to furnish certain pri�ate or <br /> confidential information, - <br /> �'ou are natified th�t; <br /> 1. The infoimacion you furnish will be used to dccermine your q�►aliftcacion for the permic or iicense requosted. <br /> 2. You may refvse to supply daca. bue refusa►1 may require thac ehe City deny the petmlt or liccnse. <br /> 3. The inFormaiion may be shared wich othac loeal, state or fedetal agencies to the extent necessery to process <br /> the permit or license, � . <br /> • 4. . Yf your cequeeted pecmit nr lieense tequires Council setion co ap�rove, some infannatlon may beeome <br /> ' public. <br /> 5. You have cercain righcs under M.S. 13,04 (avoilable upon request) to review private data on yourself. . <br /> 6, Yaur fuq name as required �o process tbls app]feation or permic. <br /> � � . . <br /> , ' F;rsc \ O � Mwd � Las� <br /> 1 `� <br /> � � � - ;� ��a ��� <br /> � <br /> Cl�q . - S�� Zip Phone //��( � �—// <br /> , . . j — Y _�[_, . <br /> T <br /> ' i•uaderstand my righte as aced above. <br /> 8ignacu� _ . <br />