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, - C�TY OF ORONO � 6124730510 09/24/96 14:00 � :03/03 N0:522 <br /> Sac_13.04 RIC,I�TS OF SUHJECTS OF DATA <br /> Sulxi. 1. Type of dats. '1't►e riyhis of individual oo�rhom ehe da4 ia srored or to ba s�o�ed shall be u sec fonh!n this secdon. <br /> Subd.3. Wormatlon rpudr�d ta be�lven Indt�►iduai. M individuol esked m supply privaa or confideedvl daa cancarcdng himaelf shall <br /> be fnlo�of: (t)the pucpose and intended use pf the►equescal dam within rhe collecdnQ Etam ageacy,yolidcal sut+divisian,or stateuride rysmm: <br /> (b)vrhe�her he may refuse or is legally required co supply the requesud d�u:(cy any leroam eonsequente atising from his supplyln�or rotUsing to supply <br /> private oc coqfldential da�;and(d)�e idennty of odx�persons or eudoes authori2ed by suir or fedenl law m receive[he da�a. Thts requiremeac shnll <br /> noe npply when an individual i9 esked to mpply in�esrigadve dan. pursueni co cecdon 13.62, subdivision S,to a law enforcement ofPfcer. <br /> 'Iha commissfone�2P fevenue mav alace �h¢ noqce r� irsd under is subdivisipn in ilee individu�l income rax or oroosm r�x rol�lind <br /> i{�ruc�lont jgs ad u[on tho�o tQrms. " <br /> SuEd, 3. Acee�s to data by indlvidual_ Upon rcquest to a �esponsible autbonry,en indiYidual shall be informed wherher 6a la the suhjecc <br /> ot uorod dara on individuals,and whed�ar ie is elassified as public, privite or conPldential. Upon his tl�rther rcquest,an individual who is the subject <br /> of�co�d pri���e or public daar nn individunls s}ull be shoWn�he dau wi�houc any charge u�him and;if he desires,shaU be informed of the contenc <br /> rnd meaning of�hrt dau�. After on iiuli�idusl hss been shown i1►e pcivam d¢ra rnd iafortncd of icv meaning,r1►e daa need nnc bs disclosed�o him for <br /> ai:awnrhs chereafter uNeaa �dispu�e or�crion pursuan�to �his secdon;s pending or addi�onal dara on the individual has beea collecred or creatcd. <br /> '7'he rseponaible�uthpriry 6ha11 p�o�ide copies of the privam or public da�upon�equeu Dy dte individua!subjec�of die dara. The rosponsible au�honry <br /> may requife the requeannQ pmnon to pay d,e acael cos�of making.cervtyinQ.uid compiling rhe copiea. <br /> Tho rcspunsible au�horiry shall comply immediuely, if possible,wi�h any rcyues�made pursuant w�his subdivision,or wi�hin fi�e days of <br /> �he date af the reques�,excludinQ Sawtdays.Sundays ond legal holidays,iF immedlace complianc:e is not po9sible. Jf'he cannot comply with�he requesc <br /> within tha�tlme,ho ahall eu inform cha individual,and m�y ha�e an addirion�l five d�ys w1[hin which to comply With the request,axeluding Sawrdeys. <br /> Sund�ye and le�wt holldiys. <br /> Subd.4, Rotedure wh�n dnta�s not pceurota or eompltte. An inJiv�,lud mry conmsi rhe accuracy qr complerenoas of public or privxce <br /> d�u¢oneorn�n�himselP. To exarcise�his right,an individuel shall nodfy in wriqnp the rosponsible au�►ur�ry describing d�e neturo of rhe dlaagreemenc. <br /> 'ftie ro.rpenAlble authoriry shsll wid�in 30 days ei�her: (a)cortecc ehe dxta found�o ba inaccurate or incomple�e and acrempt w nodfy pna recipienu�E <br /> iaaaunte or incaroplete dpta, lecludin�{recipien�a named by rhe individual;or(b)noqfy�he individual thac he belleves the dau�co be¢otrect. Darn <br /> �n d�puce eAsll be disclosad only if the individusl's sra�emene of disaQ�eemenr is included with the discloaed dara. <br /> 'i'he docerminncion oF�he rGspc�nsible au�lioriry may be appealed pursuani co the p��isionc of rhe adminisuarive proce�dure act reladng w <br /> concested c4ses. . <br /> pATA PRY'VACY ADYi$ORY <br /> !n accordance with M.S. 13.04, Subd.2, "Righcs of su6Jects of data", we would like to inform ynu that your request <br /> for a permit or license from the City of Orono or any oP its deputments may require you to furnish certain private or <br /> confidential information. <br /> You are notified tha[: <br /> 1. The informatian you furnish will be used to determine your qualiftcation for the permic or Iicense requested. <br /> 2. You may refusc to supply daca, buc refusal may require that the City deny the permit or license. <br /> 3. The information may be shared with o[hcr local, srate or federal agencies to the excent nec�ssnry to process <br /> the permi� or l�cense, <br /> � 4. . If your requested permit or license tequires Councit action to app�ove, some infarmat[on may becomc <br /> ' public. <br /> S. You have eercain righcs under M.S. 13.04 (available upon roquest) to review private data on yours�lf. <br /> 6. Your full name is requircd co process tbis applica�ion or permit. <br /> . �� l'�lil� `/Z�r L �Dl�►�'l U►�'S _ <br /> , Firsi p� Mid Lasc. <br /> �I o2 CG S f O�� ��'eG�� <br /> ,�aa�a � o .�n �/�tJ� �Sz/aU / S�1-�a8".5� <br /> C��, Snm 2ip Phone <br /> ' I�uaderst ' hts as s ed ubove. <br /> Sidnn <br /> l <br /> Received Time Seu. 24. 1 :42PM Print Time Sen �d 1 �Q�PM <br />