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� ! <br /> Sec.13.a-t RIGFiTS OF SLBJECTS OF DaTA <br /> Subd. 1. Tvpe of daca. The righa of iadividual on whoa�he dara is s;or.d or m be scnred shalI be as sec forrh ia chis secrion. <br /> Subd."_'. Information reqirired to be�vea individual. .�+n individual ask:d co suFpiy privatt or con8dendal dara concerning him.self saalI <br /> be informed of: (a)[he purpose and in[.aded use of ctre «quested daa wichin�c collecdn3�acr.a;eaty, polidcal rubdivisioa,o�sne�wide rystem: <br /> �b)whe:her he may rfuse or is la3a(Iy required w zupply ehe requested dan;(c)a.^.y Icown coas`queace arising frnm his supptyin;or refusing co suoply <br /> privarr or conr:dendal data;ar.d(d)the idendry oi o�er persons or enades auchoriz:d by scac_or fed�rsl law co rceive�h:dan. "Ihis requir_mea�stiall <br /> not apply whtn an individual is asked to supply invesdgauve daei,pursuaac ro sec�on 13.82, subdivision 5, co a law enforeWeac o�cer. <br /> The comr,ussioner of rvenue r�av vla:: che nocce e-�uir_d ur.der this subdivision in the individual ir.come ttt or orooem mz �efur.d <br /> insrrucrions insce�d of on ehose forms. <br /> Subd. 3. access to data b�individual. lipon request to a rtsponsible auc.horiry,an individual shall be informed whecher he is the subjec� <br /> of stor_d dara on individuals,and whe:�er it is clusified as public, private or con:.�_adal. L;gon his fur,her request,an individual who is the subjecc <br /> of stor=d privace oc public daa on individuals shall be shown che daci wi�f:out any cair3e rn hia and,�if he desires,shall be iafocmed of[he conc:r.c <br /> ar.d meaniag of chac daa. After an individual hu been shown che privam dara ar.d iniormed o[irs meaning. [he dact need not be d'uclosed tn him for <br /> siz mone,`u d:ereaitir uriless a dispute or acrion p�s:suane to ehis secrion is pendi.g or addidoa�l daci on the individual has beea collecred or creamd. <br /> The cesponsib(a au�horiry shall provida copies ot che privace or public dar�upon r�:,uesc by the individual subjecc of cf:e daa. T'a_responsible au�horiry <br /> may requir che roquesring person to pay the acaial cos¢of makin¢,cerrifying.u:d.ompiling the copies. <br /> The responsible auchoriry shall comply ir.ur:ediatety, if possible, wich a:�request s3de Pursuant w this subdivision,or wichin five dsys or <br /> the date of[ha requesc,excluding Sanirdays,Sunday;and legsl holidays,if immed��compliarce is noc possible. If he cannoc comply wich[he requesc <br /> wichin�hat acne,he shail so inform che individual,u:d may have an addirioaal fiv:days wi�hin which co.omply wica the request,excluding Saturdays, <br /> Sundays and le3s!holidays. <br /> Subd.4. Procedure when data is not accurate or complete. �+.n ir.dividual may concest[he accuracy or compleceaess of public or pri�•a[e ' <br /> data cor.ceming himself. To exer:ise chis righc,an individual shall noafy in wrir:c;'�:resporsioie auchoriry describing�he nan:ro oi thz disagreeman�. . <br /> The responsibla au�horiry sh�li within 30 days ei�`.er: (a)correcc�k:e data four.d m`:inacca3�or incompiece and aaempt to nndfy past recipiencs of <br /> inaccura:e oc incomple:e dara, inciudin3 recipieaa named by the individual;or(b)codfy e2:: individuai chac he believes the daca to be correc� Da� <br /> in dispuce shall be disc!osed onfy if che individual's sncemen�of disagreemeac is ir.:uded wis.�[h�disclosed dan. <br /> The dece:minadon of chz rzsponsibl� auchoriry may be appealed pum.:�'.co the provisions of chz administradve pro:edure act relating co <br /> contes::d cases. <br /> DAT� PRIVACY :�D`'ISOR�' <br /> In accordance wich tiI.S. 13.04, Subd.2, "Righcs of subjec�s oi da[a", ��e would like to inform you that your reauesc <br /> for a permit or license from che Ciry of Orono or any of i�s depz.ments may require you to fumis� certain private or <br /> confidencial information. <br /> You are notified that: <br /> 1. The information you fi:rnish will be used to determi;.�your qualification for che permit or license requested. <br /> '� You may refuse to supply daca, but refusai may reeuire that the Ciry deny the permi� or license. <br /> ;. The information may be shared with ocher local, s�a:�or federal agencies to the exceac necessary to process <br /> the permit or license. <br /> .�. If your requested permit or license requires Council action to approve, some informacion may become <br /> public. <br /> �. You have cenain riQh�s under �i.S. 13.04 (availabl= upon request) to review private data on yourself. <br /> 6, Your full name is required to process this applicac:en or pe:mic. <br /> G��a� ���� f/����'�'d���e�? <br /> First �tiddIe Last <br /> (�� �"• <br /> 1�ddrss �'�//1 �J�,�� /C � �`�G� <br /> (/l/��U���� � / 1.�� 7�7 � <br /> C`ry Sa` Zip Ph.oce <br /> �, <br /> I understand ri� ta[ aoove. <br /> / <br /> ' �, <br /> ignacurc _� <br />