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Rpr 19 06 11 : 45a Trebil Foundation Inc 3209748896 p. 3 <br /> icc13.W RIGF[7'3 OR SUH.IF_CTS OF DATA <br /> Suhd.l. 'fypc oFdali Thc righlv of individwl an whom lhe d.ila is stored or lo bc slo�cd ehall bc�scl forth m this scetion. <br /> Sutwl_2. I�fonna[an ccquirod tn bc givm individwl. M individual aelad(o supply privatc orco�dvnlial daW concaning l�imscllshall b� <br /> info�nul af: (a)U�c pu�+oAc and inlendcd une oClha rr.quesled daL�witJ+in Uio collecting slnle agancy,polilicaf eubdiv�vian,or slatawidc systcm;(A) <br /> wLc��cr I�c may teFuxe or i9lcgally requiral W aupply lho roqu�ted dala;(c)ony lmown consequenco ariao�g 6mn hix supplying o�rofiuing lo auppJy <br /> priva�eorconTidenli�ldata;and(d)U�cidcnlityofotherpersonsorenliti�aulhorrzcdbyalnlcorfcdvallnwlnrtxcivelhadala.ThiSroyuin�nc�tshaf) <br /> nut apply wl�en me individual is askcd ta nuppty iirvesligalive dnlo,pu�sunnl lo seelion 13.8z su6division 5,lo a law cnCerrccmenl u[Ticcr. <br /> 'T1w commixeion�v of rcvrnuc mnv nL1oe lhe noticc rcquired undcr thiq subdivision o�Ihe indivi�Lul income lax or oroncYtv L��c n:funJ <br /> inscructiona inxtcad of an Ihosc forms_ <br /> Sabd_3.Accas to dala by individual.Upon rcqueat b a respoaablc authorily.an individual ahall bc in(vrtncxl whc0�cnc�ix Uic nubjcct of <br /> storoJ da�s on inclividu�ls,and whelhcr it ia eVssified as puhlic,privrle orconfidential. Upan liin furlhcr rcqu��an individual who ic the subj�:cl of <br /> ulnreJ priv�tc nr puhlic dala on inJiviJ�uh cl�all bc shown thc da1�witltout any charge to him aqd,iYhcdcxires,sMall bc infortnul of16c conlcsd and <br /> nu:aoing of Ihat data. Aflrr an individual has been shown 1he pmrrl�data and info�noc!ofits v�ning,ihc datn nmi nol bc diyclosedto bim forsix <br /> mnnU�s Iherea[iet unle�e a dispule m aetion pur�uanl Io Ihu secUon is pcnding or additiooal�1.i6i an U.c i�dividuai h�e b�n rnllcctcd or cn:alcd. '11.c <br /> �tatponsiblc authocity sball proviJc eopits of lhc privatc or puhlic JaLt upaa�quesl by Ihe individual subjccl oFlhc data. '17�e rcxpoicaiblc aulliority <br /> moy rn<�uin:Wc n:quc9ting person tn pay thc acuul cosfs ofmaking,cc�tifying,and com�riling U�e copis. <br /> Tho roponvi6lc authorily ahall eomply inunediatcly,if posy b1e,w i W any r�uesl maelc p�asuanl lo ihis subdivuion,�r w:W in fnrc dayn of <br /> 1hu da/o oCUro roqu�l,cxcluding Salurdaye,Sundays and Icgal holidnys,iFimmcd iatc compliancn is nol posa blc.If hc cannvt comply wi1k�lhc rcyu�wt <br /> wiU�in lhst limc,hcsshali so infartn Uu individual,andmayl�uvcan addilianal5vcdays wilhin which Io mmply wilh U�c rryu�wt,cxcludin3 Saturtlayx, <br /> SunJayx and legal hnlidays. <br /> Subd.4. Prcwcdurewhrndstaunolacc�aleorcomplctc_Anindividualmay�ntcatlheaccnracyorrnmpinl�,�nnxofpublicorp�ivntcd.il� <br /> canccming him.rclf. 'Co excrcisc U�in righl,�n mdividual ahall notJy m writing Ucc revtwnai6leaulhority de�crihing 1hc nalwc ofU�c divagrccmrnl.'fhe <br /> t�sponxiblo aulharily ehall wilhin 30 days ciUicr (a)cortccl Wc doia found to 6c inaccumtc or incomplctc anJ atumpl In noGly pas[rc+cipicntv oJ' <br /> inaccural�s orineomplcte dala,incluJing recipienb namcd by WcinJividual;or(b)nolify Ihc individual Uiall�c bcli�ves IMc daW 1n bc cortecl_Dala in <br /> diapulc slwll be Juc�asul only iClhe individuaPs sLilvncnt oEdisngrcanerct ia inclvd�wilh tha dacbsed dala. <br /> TI�:dclem�inalian oFU�c t�.apanai6lc authority may bc app�lcd pursuant l0 11ic prov�viane of thc adminiatrativc proc,cdure act n:iating�o <br /> con4.�s1ul ea.�`;. <br /> D�►TA PRLYACY ADVISORY <br /> In nccordance with M.S. 13.04,Subd_2,"Rights of subjects of daia",we would like to inform you that yo�r�quest <br /> li�r a�x:nnil or liccnsc(rc►m lhc Cily of Orono or nny of its dcpurimcnls�nay requirc you to!'umish certain privute or <br /> conlidcnlial information. <br /> You an noti(icci thaL• <br /> l_ "fhe informalion you f�unish will be used to deterrnine your qualificalion for lhe permit or liccnsc <br /> rcquestecl. <br /> 2. You may r�efuse to supply dala,but refusal may require that the City deny the pc,�rrnil or lieense, <br /> 3. 7he informakion may be shared with other local,state or Cecleial agencies to Lhe c:tle.-nt necessary to <br /> proccss the petmit or license_ <br /> 4. lf your requested permiY or]icense requires Council action to approvc,somc infoRnation may becomc <br /> pub)ic. <br /> 5. You have certain rights tmder M.S. 13.04(avaiIable upan request)ta rcview privote dala on yoursell: <br /> G. Your Cull namc is requirccl to prooess this application or permit. <br /> �l Q�� Tr��,�! ,�,�(��.'� ����s-,�eorrS t�-�-r,� <br /> Firsl Middla LASI <br /> �Da ��� ��- � r,� <br /> AJJr�� <br /> �4�c�a�-r- .-�-i n� �6 a�y 32-�-- y,y��Z� <br /> Cily Statc 'Lip Yl�one <br /> I undcrstond y ri�hts as ctated above_ <br /> ' ^ rJ�fi�cP 7/! <br /> Sip�aturc <br /> KCSCI('011Tl 32, <br />