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TY OF ORONO � 6124730510 09/24/96 14:00 � :03/03 N�:522� <br /> Sec.13.04 RIGI�TS OF SUBJ�CTS OF DAT.1 <br /> Suhd. 1. Type o�dscs. 'Itie [1yh�s of indlvidud on whom the da4 is smred or to be:tored sh�ll be u set fonh!n thfs secdan. <br /> Subd.3. Wormatlon riqtdnd ta be ei►en iadtoidual. M Individuol as�ed to supply private or conRdeeutl dna¢onceriilng hLnaelf Rhall <br /> be fnfo�mM of; (�)�te purpose�nd inunded use af the requesuxJ data withia the colleednQ 1nu agency,poUdcal subdivisian,or stue�.�ide rystem: <br /> (b)wfiether he may reruse or i�legtlfy tequired ro supply rhe roquesced dva:(c)uny known eonuquence arising from his supplyln�or rofl�sing to supply <br /> privaca or co�(Iden�i�I data;and(d)�11e Idenriry of odur persont or endoes author+zed by suie or fedetal l�w[n rCceive rhe dara. 1'ht1 requlremetu shull <br /> noi apply wheo an fndividual i�nsked co fnpply investigadve daa, pursunn�io ceedon 13.62, subdivision S,to a law enforcement o[ficer. <br /> Tha cum�ni"ssgnC[ f �venue ma� alace �he nonce reauirad under t1 is subdi�isio in �he irtdividu�l income rax or oroosttv �x:�el�nd <br /> i{�p��,►on��q�s ad uf on�►o�c form�. �� <br /> SuDd, 3. Aeee�a to data by indlvidual. Upon rcques�to a rcspunsiDie au�horiti,�n lnAi�idual shall be informed whecher he le ihe s�ibjeec <br /> ot�wred dara on individuals,and whethar ie is cl�ssified a�public, private or conPldenrial. Upon 6is tUrther rcquest,an individual who 1�d�e subjact <br /> �f�wred pri��ce or public da�a nn individunls shall be sho�+rn �he dan wi�houc any chu�e u�him end;if he deairos,she11 be infonned of rhe eonront <br /> rnd meaning of d��e data. After�n individua!has been shown�he printa dnta�nd iafortned of its meaning,d►.e daa need noc be diaclosed to him for <br /> tlx ewnrhs thcreafur unlet� a dispu�e or�ction pursuan[ro �hia secdon is pendin�or addi�ional daa on the individual hos been eollec[ed 4r crear�d. <br /> 'I1ia rs�pntuible�uthpriry thtll pro�ide copiea of rhe private or public dara upon rcquest by�he individual subjecc of the dara, The rceponsible au�ho�iry <br /> �vy require the roque�tin�person ro pay die ac�uel c�s�i of making,certifyino.uid compiling�e eopies. <br /> The�sponsible auth�riry shall comply immedi�taly,if poesible,wi�h anr requea�made�x,rsuant m rhis subdivision,or wiihln fi�e days of <br /> rhe date of the Teques�,excludinQ Saturd�ys.Sundays�nd legd holldays,if immedlaea complignce is not possible. INhe eartno�comply with�he rcques� <br /> wld�ia chac dme,he�hall w inform rha Individual,and may ha�e sn addirionzl five deys wid�in which co comply wf�h che roquesc,exeluding Saa�rdays. <br /> Sbnd�ye nnd IeQwl holldaye. <br /> Subd.4. Roeedure when dnta is net oceurste or eomplete. An inJiv�fual m�y conms�rhe accuracy er complerenoa�of public or priv��e <br /> d�a eoneernlnj himself. To exercise rhis right,vn individuel shall nodl�in wridnp�he roapunsible su�hudty describing d�a nen�ro of�he dfsegroemenc. <br /> The ro�penalble�uthoriry dtell wid�in 30 days ei�her: (a)correcc the dam found�a be inaccun►te or incomple�e And stcempt ta nodfy p��e recipfents ef <br /> inaeeurtte or incaroplete dpra, Includin�{reoipienta named by [he individual;or(b)nopfy�he individual chec he belleves the dan�ro be oorrec� Dara <br /> �p d�pute ih�ll be diaclosed only if the indlvidusl's sniement of dls9Oroemnnt is includad wirh�he dieclosed dara. <br /> 'i'he detem►inn[ion ol�F,e rrsponsiblt au�horiry may bo appealed pursuani eo the pm�fsionc ot�he adminixwrive procedure act relatine co <br /> concested ca�es. . <br /> � pAT�i PRIVACY ADVI$QRY <br /> ln a�eordanee with M.S. 13.04,Subd.2, "�tighcs of su6Jects of data", we would]ike to inform you that your requesc <br /> for a parmit or license from the City af orono or any of its depar[ments may require you to turnish certain private or <br /> confidential information. <br /> You are notified that: <br /> 1. The informetion you fumish will be used to determine your qualiftcation for�he permit or iicense requosted. <br /> 2. You may refusc to suppiy d:ua, bu� refusal may require that the City deny the permit or licc�tse. <br /> 3. The information may be shared with o�hcr loeal, state or federal agencies to the extent nec�ssary to process <br /> thc permic or lkensa <br /> � 4. . 1f your requested permit or license requireo Council action co approve, some infarmat[on may becomc <br /> ' public. <br /> 5. You have cena�n rights under M.S. 13.04 (available upon roquest) to review private data on yourself. <br /> 6, Your full name is required to process this application or permit. <br /> � . <br /> . � ��'�i�CA � -- <br /> . � Fi i C- •�� � �le Lut. <br /> .1.�..�� � � - <br /> AAd�s �1� � ��-1�—=��`// <br /> ���� .�.�� �J��� <br /> Clcy Sd�e 2ip Phon� ��� . <br /> 1•uaderstand my rights as s[aced above. ( <br /> Si�n��un <br /> D.,,.. . .._ ] m� n n, � �nn,r n_ � � in, � .. . . ,...... <br />