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CITY oF ORONO � 6122494616 05/14/99 13:28 � :05/05 N0:334 <br /> s�.t3.o4�uc,�rrs o�sua�c�cs or�n�T� � � � <br /> �ubd. 1. '1�pe o[datd. Ihe ri�t�u o(individa�l on wtsetn tbe d�u ii staced or to be emtsd�htll ba ta�et forth in thfy secdop. <br /> Subd.2. Iaforn�t�Uon r.eq�red W be tirm ladlvidual. M itidividual tsked to suppl�pr[v�oe or confidendu d�u concaralzt�hlmzclf:hxlt <br /> be lt�foctn,ed ot: (�)the purpoae and intondad uaa of tha ceqve�cct d�m wlthiu m+cotSecdnQ Yram adency,palidc�!aubdivision,or nacewlda rystam; <br /> (6)whethar ho may YtNse or i�lo�ily requitad to tu pply the seque�tod dtn:(c)�nY kno'nm conse9Uanca�rialn6 from hir�upplyinE or nfusia�ro aupPlY <br /> pdr�ta or copftd�nd�l du�:And(d)�e idendry af other pessotu or eatidea authorized by state ar federEl l�w oo receivo the data. TMs requlrement ahaII <br /> ��yPp�y rvhen an Indfviduil Ia ukad m supply invesd��tive drea,pursuant to aection 17.a2, subdivuion S,so x 1ew ee[o�+cers�pt otAcer. <br /> '� c�mmissivnst of R�anua mav nlaca du notiC�i�oulred t�4F d116 i+tbdiYlf�on in tttc fndl�idv 1 incomt pfa a�orooectiv tnx rcfl�nd <br /> �en+�r+�i,s inet��td�f en ihom fornls. <br /> Subd.3. A�to d�ta by indl�'Idual. Upon tequasc to�reaponxible�uthodry,m indivkluai sha11 be I»tormed Mhathat 6a is the lubJace <br /> of twted dati on indtvfduala,and whsthet it is c1Res(lied u publie,priv�u or canfidendat. Upon his furthor r�queat,aa indiv;du�l who it the aubject <br /> of tpoced Pdvaw or public dAcx o�lpdividu�ls fhsl3 be thown d�e d�ee wichuuc any ehaRo w him�nd;U he de�iros,�hali be in[ormod Ot�he conaonc <br /> �nd me.�ot thac d�u�. /�rer Rn individtul M►�beee chnwn tha pRVRoe data�nd informad of la meaain�,fie data need not 6e dtselo�ed m h!m far <br /> aix mon��tharnahec unleas�dispuen.or action�rur�usnt eo rhi:ieadan i�pend�or�ddlconal dRa on die(ndividu�!hss been coileceud or ereated. <br /> Tha�pottsible�,utlwr4ty tAdl provida aapie:of thc privua or pu6lie d�at upon raquest by�he ind[viduit sub}at of the data. The reaponsibl�nufioriry <br /> may mqnire d�requettiag penan ro pwy�he actaal eonrs of mnlcint,cerdt�ini.�utd compilin�dm copies, <br /> 1'he rsspontlbk suthorit,Y stutll comply immcdiately,if po4�[�le,wi�h�►Y requs�t m�de�wnuxt►t to this subdivision,or withtn[tve days ol <br /> fhe d�x oc'tha rvques�txctadin�Senuday�,Sunday:u�E Ingd holidays,if immadi�oe cempiiaaco is no�pos�ibie. If Jl�08MOt CRI11PIy W��1 U1E fQQuE6L <br /> wld�Sn thu t�crs�s,he�hali�o inform the ina{vidu�t.and m�Y h*va an�ddldonat lSvs d�ya wkhir�whlch to compty wid�the roquaac,EXC(UdIRi SANPd1y9, <br /> Sund�yf ndd l�Yal holld�yf. <br /> Subd.4. Pro�c�dure wh�p dal�w not occurAte or complet�. An individusl amy coateyt the securacy or comptetenaa oi pdblle or private <br /> daa concerntn�himselc. '�o uxsrciu this ri6ht,in inQkvidval sh�Ji noti:fy in wrltinQ the nspocuible�uthnriry dcscribine tha n�tun ot the diu�rcomen�. <br /> T1u ro�ponaibla�uthoricy�h�t1 wi�hin 3�d�ys eithec (i)wmecc�he d�n found W be i:uccutwte or lncompte�a and attempt to rwdfy p�at t'ecipfenta of <br /> inrccunm or incoinpleu dRa,inGludin�reciplenu named 6y tha iixifvielu�l:or(b)nodtY�e individual elut he baliavee che dals to be cor[ecc, D■e� <br /> 1n dl�te Rh�ll be diacWsed only if tha Individual't set�mmsnc of di�aYraemant is inctuded wirh the dtsclo�ad dua. <br /> 'Il�o dewrtnin�sion ol�tie respon�ibk�uthodry maY b�1PPeA�ed P�rnnn�m d►e pravision�of d�e�dminlsandve procncivr�ect rotadng m <br /> . aoritrAtad c�tai. <br /> �A'r'A PIL1"VACY ADVIS4AY <br /> In accor.danc� with M.S. 13.Q4,Subd,2, "Righcs of aubjxts of data", we would like to inform you that your request <br /> for a permit or Ileenae fr�m the City of Orono or any af its dcpartments may requirc you to fi�rnlsh cortaitt private or <br /> coafldenti�t 'tnformation. <br /> You Are �otit�ed that: <br /> !, The informntion you furnish wlll be used to detcrmine your qualification for thc perrnit or license raquosied. <br /> 2, You mAy rofuse to supply data, bui rehisal may require thAt the Ciry deny the permit or ]iccn�e. <br /> �, Tbe infarmation�ay,be shai'ed with ather locat. 9tate or fcderal agencies to the excent noeesaary to process <br /> thc permit or license. <br /> 4. If youF requested permlt or liccns� requires Council action to approve, somc information may become <br /> public. <br /> S. You have cetcain dghts undor M�S. 13.04 (available upon request) co review private data on yourself. <br /> �, Your full nnzne �s required to process t�►is aPplication or parmit. <br /> ��E T.r -�-w IE LEN <br /> First Middle ks� <br /> P2Go� G2EEKvlc� ��e �� <br /> �aer.0 �V�G C ,.. M r� � � ��� 612,� . <br /> Ciry Snc� � Zip P ono qQ� '_��17 <br /> o V <br /> I uadcrttand my riBhta ss stacad above. , <br /> _ _ �� <br /> 3tQn.Nre/ <br />