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�Y OF �RONO � b124730510 09/�4/9� 1�:00 � op3�03 NQo522 <br /> � . <br /> Sec.13.04�1C1�Pfl'9�F SUHJ£C'�S�F DA'i'A <br /> Subd. 1. '8y�a of d�ta. 3'fle d�bts of endlvidud o�s whom the data l�scored or w be sco�e�i shill be ai sat fonh In this secaan. <br /> Subd.3. IaParmotlon requdrad tu ba�Ivee tnd(•idual. An ladividud asked to 9uppiy privace or oonfldenti�l data wnaerning himaelf shall <br /> be Intotmed of: (t)dta pu�pose at�intended uu o�the vequesced d�ta withiu the callccdnQ Dtue agenoy,polldcal aubdiYisian,or�ntetivide systnm: <br /> {b)whether b.may reflise oi is legaily required w suppiy rhe eaqutssed daa:{c�any kaou�n consequeaee aciring from his supplytng or reP�sing ro supply <br /> privato or cenflden�L�!data;and(d)�he idendry o!odie�persont or endries authorized by su�e or fedetal lAw Yn r�neive rhe dara. T'hi�tequircmenc shull <br /> not apply when an inrtividuel is askcd�o supply lnvesrig4dve daa.pursuant ro seodon 13.�2,sabdivision S.eo�law enforcement ofPfcer. <br /> ,.� <br /> '�j►a eum�,�sfaner P evenue m� alace ihe ao�,ce rc ircd under his su6diviste�n in itee indtvidu�l income tsx or oroosm r��;reftiind <br /> __., lY1LUYCilont in�r���u�on�hoeo fgrm�, „ <br /> SuEd,3. Aeeeas eo data by End[vidual. Upon rrquesi ro a�espnnsible autha�ry.en indi�idual shall ba informed whaiher he la the s�ibjeec <br /> o[acored dara on iadividuals,and wherhar ic is elassifted at pubtic,p�ivice or conPfdepdal, Upon 6;s f5�cr1►er rcquest,an individual who is rhe subjaet <br /> of acored pri�are or�ublic dau on individual�sFull be shown�he dara wi�houc a+�y ehaeee w him snd;if he desfroa,shall be infonned of the content <br /> r1u!meaning of d�at daeu. Ahet an imlividual hts beea shoWn the pdytie clara and fafom�ed of i�s mesning,thc dara need ewrba dixc)osed to him for <br /> a!:mnnd►s theraa�er uNes�a dispu[e or 9crion pursuanc m ohis seedne es pendfn�or addirional dara on the individual has been oollecced or creatcd. <br /> 11�s r�spnnribie�uthpriry chall proVide copies of du pdvue or public dara upon roqvesc br�he individual subjae�of�e dara, 'Phe Y+esponsible authariry <br /> awsy requira rhe roquesrin�parson ro p�y�ho aetuel cosrs of mafctng,csrtifyinQ.snd compfltns die aopi��. <br /> 'il�e Pespoeisibte suthoriry.chall comply immedi�tely,if possible,wich aay requesc mede pursuant w thu subdivision,or withln five days of <br /> d�s dare of ehe requeaG exNuding Satutdays.Sundays and leg�!holldays,if immedlace compUancc is not po9sibla If�he catmot somply wieh tha eeques� . <br /> wlthin eha�cLno,ho ahali ao it►Yorm eha individual,and may ha�e�n addlrional FiVe d■ys wid�in which m eam�ly�hh the request,excludiag Saa�rdays. <br /> 3bndoya and IeQwl hol(dtys. <br /> Subd.4. I°toeedue�wh�ti aln�a is net ac�utata or eomplete. An indfv�funl nuy contsu tMe acctuaay er complerenos�of publlc or priviva <br /> dott concorn�himselP. To exercise+his right,sn indi'viduel sha{!woally in wtidng the reapunsible auehodry daeTibing d�naatre ef tho dl�egroamcnc. . <br /> The�eapunplble authoriry shell wid�in 30 days ei�her. (a)eorrec�die data found ro be inucunte or incomple[e and eaampt te noafy pric raeiplencs oE <br /> ineeeucnte oe fn,camplete dpra, includin�racipienta named by�e individoul;or(b)notiPy the individuat that he belleves tha dara co be cotrecL Da�A <br /> ia�kpu�e ehsll be diacloaad aaty if tha in�i(vidwl's saiemant of dlsa�reemnn[is includad with rhe di9cloaed dara. ' <br /> �'he decermination oP che responsib►e aud�oriry moY bo appealed pucsusni w 9he pmvisionc o[rhe adminisrnative praceduro act rela�inB� <br /> contested aeees. <br /> � ' 1QATA P�tYVACY ADVI$ORY - <br /> L►accordance wich h+t.�. 13.04,Subd.2, "Righcs of suk'sjeccs of daca", we would like co inform you chac yot�r requesc <br /> for a permit or licensa from che City of Orono or any of its departments may r�quire you to furnish cenain private or <br /> confidential information. <br /> '�'ou are antified th�t; � <br /> 1. The inform�tion you furnish will be used to decermine your qualification for the permit oriicense requested. <br /> 2. You mey refuse eo supply daca, but rcfus4l may require thac the City deny the permlt or licct�se. <br /> 3. The infarmation may be shared with othcr local, scate or fedetal agencies to the extent ncccssary to proctss <br /> the permit or license, � <br /> • 4. . tf your requeeted pecmic ar licen:e requires Council aetion �o approve, some infaRnatlon may become <br /> ' publtc. <br /> 5. You have cenain righcs under M.S. l3,04 (available upon request) to review private data oa yourself, . <br /> 6, Yaur full name is requirod to grocess_thls �ppl9ca�ion ot'permit. <br /> . o,�c� �ti l u �e xt�o�� � <br /> . FirsY ,� ` Middle Lut <br /> ��.��0. � a - s�.��.��, �:�a�� -- - <br /> �►aa�s , <br /> �.� z �� ' rn� ssyao 9s a . � ��caoy�-� <br /> cicq . • sn�� Zip Phoaa <br /> . � <br /> ' t•usderstand my rights a5 sta[ed above. <br /> ��� � . <br /> Bignamre <br />