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TY OF ORONO � 6124730510 09/24/96 14:00 � :03/03 N0:522 <br /> Sec.13.04 ItIG1�TS OF SUBJEC'fS OF DAT.� <br /> Suhd. 1. Type of dats. 'Ttte c1�h1s of indlvidud o11 whom tha d�C1 i9 srored or to be stored shall be as set fonh In this�ection. <br /> Subd.�. inloneatloe r�qtdr�d to ba�Iren iodi�►iduxl. M ladividual as�ed ro supply privsa or eonfideeuel d�a concerntng 6itnaelf Fhall <br /> be infe�med of; (t)tha purpose�nd inunded use ot the Tequested d�a within rhe cotleedna snu agenay,polldcal aubdi�ision,or snre,vide rys�em: <br /> (b)wfiether he may rePuse ot'i9 legally tequired w supply�he roquesud dvu;(c)any knoan coauque�u:e arising from his supplyln�or relUsing to supply <br /> privs�e or coaflden�i�l daa;and(d)fie idoncih of odur person�or endoes aud�orized by sum or tederal I�►w sn rec�ive rhe da�a. Th�requlreme�e Shull <br /> not apply wheo sn individuei ie nskeJ�o�upply lnvesrig�dve dam, pursuani�o ceedon 13.62, subdivision S,to�I�w enforcement otPicer. <br /> � cuml�sionci�ii i"c.@OUC iI1Gv place rhe nory',ce r� i d under�his subdiyision�� indtviduel income rax or aroosm ��e�nd <br /> lilE4FS1�i�.'l�l ad u�on rho:c[or�na <br /> SuDd. 3. A�cets to data by indlridual• Upon rcques�to a rcspnnsible autho�iry.�n incli�idual:hail be informed wberher 6e le the s��bjeee <br /> o[�tated dau on individuals,r�nd whechar ie is el�ssified as public,privi�e or canPldenrial. Upon 6is fUrther rcquea[,an individual who i�rhe subjtct <br /> of swred pri���e or public dpw nn Individuals shall be sho�+rn e1+e dara withouc any chzr�e to hun and:iF he deelres,shep be infortned of rhe wnron[ <br /> aM mAeu�ing of diAt dara. Aher an individutl hi�been shown ihe p�i���a d4ra tnd ia(ortr�ed of it�meaning.the daa need not be diaelostd to him for <br /> tix ewnd►a thereafur utiled� a dispute or�cdon punuan�m �his seeeion is pendin�or addiRonsl darm on the indiviaual ha�been co!lecred�+r erea�ed. <br /> Tha respc►neible�uthpriry th�ll pro�ide copies�f rhe pri�are or public dera upon requesc Dy�he individual subjecc of d�e dara, 'R�e rcsponsible au�ho�iry <br /> may requite thd requeatinO pmnen�o pay die aetuel cosu nf making,ceitityino.u+d compiltng d�e eopi�a. <br /> 'il�e xsponsible authoriry shall comply immadiately, if possible,with any request mede pursuant m d�is subdivision,or withln fi�e days of <br /> �he date of d�e Teques�.excludinQ 9amrdays.Sundays ond legd holldays,iF immedlaee compliance is not po9sihle. If�he cartno�comply wid��he roques� <br /> wi�in cha[etme,he aha11 eo it►form cha individual,and m�y ha�e en addirional five days wid�in which w comply wi�h she request,exeluding Saa�rdays, <br /> Sund�ye and leyal holldays. <br /> Subd.4, Roeedure�rh�n dn�a►s net oecurata or eomplete. An individual m�y con�es��he accuracy or compluenox�of public or priv�re <br /> d�a eoncernln�himself. To exercise rhis right.�n indi'viduel shsll noafy in Mridn�tho respunsible suehurity deacribin�d�e nemro of the df�egreemenc. <br /> The teepenel6le 4uihoriry dtell wid�in 30 days ei�her: (a)correc�thc data found�o be inaecurate or inc�mplea And sceempt to nodfy p�ue reeipfencs ef <br /> inaetunte or incomplete dpn, Includin��ecipienu named by the individual;or(b)eodf�che individual thet he belleves the dotn co be oorrec� Da�a <br /> (���purc ahsll be discloaed only if the indlvidusl's sneemenc of disa4reemnnr is includad wirh�he disclosed da�a. <br /> 'i'he detemunation of�he rrspansible.u�lioriry may be appealed pursuani eo th�pm�isionc of rhe adminiseiarive procerlure ect rel�4ns w <br /> con�ested eaees. . <br /> • pATA PRTV�CY ADVISOF� <br /> !n aocordaace with M.S. 13.04, Subd.2, "Kighcs of subJects of data", we would like to inform ynu that your request <br /> for a permic or 1[cense from che City of Orono or any of its d�par[ments may require you to furnish certain private or <br /> confidentlal information. <br /> You ue notified that; <br /> 1. The informetion you furnish wlll be used t�decermine your qualifica[ion for the permit orlicense requested. <br /> 2. You may rcfuse to suppiy da�a, buc tefusal may require that ahe City deny ;he pctmit or licen9e. <br /> 3. The information mey be shared wich othCr loesl, s[ate or federal agencies ta the excent necessnry to process <br /> the permic or licensa <br /> � 4. . Yf yout requested permit or license tequires Council action [o approve, some infprmatton may becomc <br /> ' public. <br /> 5. You have cenain righcs under M.S. 13,04 (available upon roqu�st) to review private data on yourself. <br /> 6. Your full name is required to process this application or permic. <br /> , � Firci Middle Lu�. <br /> AAdr�s . , <br /> Clcy Sn�e Zip Phon. <br /> ' 1•understand my d te s ed above. <br /> � <br /> 8ienaaro <br /> D.,,.. . ... � m�. n n. � .nnir n. � � In, .. .. . . ....... <br />