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TY OF ORONO � 6124730510 09/24/96 14:00 [�7 :0�/Q3- R9:522 <br /> _ � <br /> s�.i�.aa tt�sr��oF scra�r�cTs oF n�rx <br /> Subd. i. 'L�pe of dac�. 'I8e d�bu o[fcdividw!oo v�hom the data 1:-nored oe ro be smced shill ba a�see focsh in this uedcn. <br /> Subd,l. InPormrtlan reqtidnd to b��l�►sn Ind(.idmi. M IadiWdud ulcad ro aupply priwa ot oonfideatia data wnasrning himtelf,�hall <br /> ba Intom�ed oL (t)tl�a purpoce and inuaded uu ot d�e Rquesr�d d�ta widdn ehe caltecdnQ ltace age�y.PoUdtal tubdlvisian,or�nteu�ide syimac <br /> (b)nrhether M miy rahise ol'u leealty nquired m supply the raquesced data:(c)arry known eonsequenee aritit►g from 6k supplyln�or�eArtlny ro supply <br /> privace oc conftden[Ia!d�a;snd(d)�he idenricy o!odie�persom or eedoes aurhoci:ed by su�or fedenl I�w m recnive d�e dara. Thf�requircmaic sdull <br /> not apply when on lndividud i1 asknl co mpply iavetri6�dve daa.pursu�nt ro cecdon 13.82. tubdivision S.to a I�w eaforcernenc otfFcer. <br /> ., <br /> '�m cum�i�s{gner QP rcve�tue m9� olace the rtoc�ce re ircd under u subdi�isian (a �h� indivfdual incoeste tsz or oroosm �rolUnd <br /> _ -� j�F,y�,dont i��mud o[on rho�o�orm�. " <br /> SuDd.3. A�ces�to data by[ndlvtdual. Upon rcques�to�respaasible wthonry,tn iadiYidual shall be tnformed whasher he b the subjecc <br /> a[rwred d�n on iadividw�is,and wfud�ar ic ii cius[Fied a�pubtic.P�ivue or confidecuial. Upon h;s tUrther rcqueae,�n tndividual who is che subjxt <br /> of uorod pri�aee or pubUc dau on individutls shill be shoWn�he dua wi�houc ury e6ar`e co him and;if he det(ras,ih.il be infortned of ihe co�itenc <br /> �nd mbenins of thae.daa. Aher an iadividus!!u�been shoWn�he pdv�te d►rn�nd infom�d of in meaning,the daca need aurba diseloud co dim far <br /> �ia enoeuFu tkersahnr unleu a dispuce or rction punuan�m �his:eeefan is pendia�or addirionai dau on the ind�vidud l�as been oollecced or crcated. <br /> 'I1is rtsponiible�uthqriry cfull pro�ide copiei of ehe privi�e or public dsa upon rcquesc by�he individual subJee�of da dan. 'I1�e re:ponsble au�a�icy <br /> quy requite che roquestin�person ro pay�he a�:ael cos�s of maklns.oertit�in`.and compHtna ehe eopf��. <br /> The oesponeible wthoriry.�hatl comply immadiately,if possibk.wfdt aar request medo purcuattt w dtu subdivision,or withln flve day:of <br /> d�s date of�he raque��.exc(udina 9uurdayj,Sundays and le;d holldoys,if inunedlaca compllana i�na po�ziblo. If�he cam�oi comply wleh rho requesc <br /> wlthln�hac c(�no.ho ahall w it►form che ladividusl,and may ha�e an.ddlriodal flve d.ys wi[hin whteh m con�ply whh�6e req►teae,exeludlpg Saa�rdnys. <br /> Stiuxl�yi�ad Icjrl holWiy�. <br /> Subd.4. Ptotedura whitti dnta is not aceuratt or eompl¢ta An fndlvpiunl nuy conosst the ucursay or complerenoaa of puWic or privam <br /> dia eoaeorn�bimself. To exercise rhis right,an indiVidue!shall aoeify in wridng du responubk surlwdty deuttbin��he naeuro of rho d(ugroe�tecnc. . <br /> Ths tesp�a�lble�u�horiry d�sll wit�in 30 days eirher. (�)corncc the dam found�a lx inaccurate or incumpteie�nd�aeeapt ta nodty pact reeipkncs oE <br /> insecunte or I►�caroplete dpn,iecludln�recipfeau nartud by�e indfvidual:or(b)notiPy�hc individuat thu he bellevea the dara to be co�reee. Data <br /> ip dkpu[e itt�ll be discta�ad ardy if the indlvidual's miemeat of dls�reement Is Includad with rhe diulo�ed dara. <br /> �'fu determinarion oF ehe rcsponsiblo auihoriry mar bo appealed pucsuwi w�pro�isionc o(rhe adminicrradve proeedum act rrl�tin�to <br /> wn�eRed cases. , <br /> ' pA'�A PRNACY ADVI�ORY <br /> !n accordance wi�h M.S. 13.04,Subd.2, "Rlghcs of sulijects of da[a`, we would 19ke to inform you that your requesc <br /> for a permlt or ltcense from the City af Orono or any a!its departmerits may nqulr$you to furnish certain private ar <br /> confidenNal iaformation. <br /> You are natified thst; � <br /> 1. The Informa[[on yon furnish wili be used to decermine your qualificacion for the permic or Iicenso requos[ed. <br /> 2. You may refuse to supply daca. bue refusal may require thac the City deny the per[nit or licc�tse. <br /> 3. The infornsation may be shared with othCr loeal, scate or federal agencies to the extent ncccssary [o process <br /> the permic or lkense. <br /> � 4. . If your requeoted pern�it nr license tequirec Council aetlon to approve, some infarmatton may become <br /> ' publlc. <br /> S. You have certatn righ�s under M.S. 13.04 (available upan request) to review private data oa youcs�lf. . <br /> 6, Yaur full name is requir�d t pracess thls application or permic. <br /> �. �;� � a o �. . �� - �d�� �. � <br /> -� z�� <br /> � lC�r�m�� �r� � a� -3 �-CoO�� <br /> ��, � Sdoa Zip Photw <br /> � <br /> ' I•uctders d my tigtits caccd ubove. <br /> 8i�n ro . . <br />