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�' . <br /> Sec.13.0a RIGHTS OF SUBJECT�3 O�'AATA <br /> Subd. I. Typo o!da�a. Thm rigbcs oP undividud on whom fie data�s Storad 0�m be s�otcd ah�ll be as se[forsb�n�his te«i�a. <br /> Subd-2- In[ormnt7on requfrad to bs¢irea fndlviduot. An lndividu�l asked a supply privau or confidential dira concensinB h�maelf shalt <br /> be inPo[med�f: (a)the�urposa and iattnded use of�ht ftqaosted det�wltbiII d►e colieCtlng 8wte a8tucy,pullrical subeiivision,or su�ewiJe syssem; <br /> (b)wherhot hs may rotLse ot is lagrily required w supply Tha requesced data:(c)any known tansoyue[�ee arising from hi�supplying or Tcfusing ro supply <br /> privn�e or confldrndai dwn;and(d)�he�dennry of od�ar perzoos u�cndnos nu�Aonzed by suee or federal taw io receiYe che dare- Tlus Rquiremen�shrli <br /> nat apply when an individual is asked m supply invcsngoavo dau,pursuant co secdon 13.82, aubd�v�sion 3, m a law enforoemenc officer. <br /> T114S.�Lnknll`��RnC►Qf C6�toUG IPav of� c che nn+ce rc �red er � su vi ion ' e i 'vidu ' � e rn o arona na rofu3 <br /> �gcNc«qs t_ srsc,�nif�f on�ho�e fomis. <br /> 5utxf.3. Accese to dela by indlvldusl. Ilppn rcqu¢sc rci a respoasible nutAority,on indiridu�l 9hall be informed whe�her he is ehe sub}ec[ <br /> of srnred drta on indlviduals,and whmdler ic is ttxsaifled aa public, priva�e or tonPdondul. Upan tua fuMer request,an iAdividual who is�he eubjccc <br /> of aeorod priva[e or public d4ta on lndiviQucJs ahall be shown �he dou wi�llou�azry chnrge eo him ond."if he desina, shall De inforinad of�hc concenc <br /> a�d mruniny of tbat dau►. AFtsr u�indrviduAl hax btCn shown the privsre da�a and informed oF ics mesning.the data eeed no�be di.9closed ro him for <br /> ��x month�thereaitac unleas v dtspute or scdon pursuant to this iection ix peoding or eddiaonal doca°n�he inAivldual has been collecad or creaced. <br /> Tl�e reaponsibla�ulhonry shell providc copies of rhe privur or publlc da�n uQon requsst by the inQividual wbjecc of ihe dao. '1he reapansible auchoriry <br /> may requiro me roquesdng peraon w pay�he acma!cos�s of making,ccrtiEYing.6nd tompiling ihe co�l�ts. <br /> 'f'ba reaponstble 1u�honry sAsll comply immcdiasely, if pas�ble, wi�h Yay rayuexc made pursuant co�his subdtvision,or wishin ftvc ciays Of <br /> if►a due of cho requeyc,exefuding Svardeys,SunAays and 1tylnl holiday9,if immedi�ce cumplianc:e is noc puseiblo. If he csru�oc eomply with the reques� <br /> W���p����,ho shal�ao iafo�m�e indfvidu4l.and may ha�e an o3diuonal fiva days wichin Whid�co comply wish�ha rcqucsc,cxcluding Sa�urduys, <br /> Sundrya and legal holldeys. <br /> Subd.4. Procodwe when d��s is not accurats or eompleie. An iridivi�ual may conceiG nc�accur�cy or compleuness of public or pri�•aie <br /> dnta conceming himsefP. Tu exen:is¢�his righc,an individusl shall��tify in wri�ing�he respoiuiblo au�hotiry describin�ch�nor�ra o![�e disagroemce�. <br /> Tha responnible aushoriry shnll Wirhin 30 days ai�her. fa)�ornce�hc doc�found ro Ge inaccurete or incomplew and aaemp[to nndly past recipiencs uf <br /> maccurata or incnmpleu:data, ineludinQ tecipienra nAmc4 by the individual; or(b)nod[y Iho irulividurl ihni he believes dia data m ba cortect. Data <br /> in dlapu�e sha}!be disclo�ed only 1f�he individual's s[aumenc�!dfsagreement is included with ehs disclosed dara, <br /> 'lhe decocminanon uf thc respons�ble authuriry may bo appenled purauant tn tho pr�visiona of the adminiatrarive procedurc acc rclanng w <br /> conu�ted casea. <br /> DATA P rA __�L��SOl2Y <br /> [n aCeordance wich Ivt_S. 13.04, Subd.2, "Righes of subjeets of detA",wr wquld like to infortn you that your rec�ues� <br /> toc �permit nr llcense from ►he City of Orono or any of its dep�ments may require you to furnish certain Qriva[e or <br /> conftdencial iaforma[ion. <br /> You are natified that: <br /> 1, The inforniation you furnish will be used to determine your qualification for che permit orlicense requested. <br /> 2. You may refuse �o supply daca, buc refiisa! may require that che Ciry d�ny the permit or license. <br /> 3. The intormation may be shared wi[h o►her iocal, sta�c or federal agencies ro the czeent n�cessary co process <br /> the permit ar lictnse_ <br /> q, If your requesced permic or licenxe requires Council accion to approve, sorae informa[ion roay become <br /> public. <br /> g, You have ceRain righcs under M.S_ 13.04 (aveilobla upon request) to review priva�e daca on yourselF. <br /> 6, Your fuli n�me is required co process this applica�ion ur permit. <br /> -� �i;��,��_ - <br /> First Middlt L�'� <br /> ��S �� _`� �,v — � <br /> � �►aa�b� . ��y1 S��r l 4 l3 ��3 J� <br /> Ciry�c.� Z� <br /> s��a Z�P PLone <br /> � <br /> I understand my righes as staceci above. <br /> __'_.__— <br /> / <br /> /� /� �"������ ( _ �� <br /> Signacuro <br />