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09/17/2001 12:55 6128058846 ABC PAGE 02102 <br /> l��s-13•2001 �08:23am From-CITY OF ORONO +852249d618 T•685 P.DDe/003 F-61t <br /> . ' , <br /> " 3ec;1�.04 RIGHT9 a�����OF DAT� <br /> Subd. 1. TTpe of data. Th�nQhrs of indivldual oa�haw�ha d���s��or m he swrsd sha11 bo ss u�forfi!n this s¢caop. <br /> Subd.2. lneormsslan ro4'��to 6e pv°n(ndf°idua!' '�,i'n�iviQus!atkcd oo supply privaa or confidmdal dafs coacerniog blrasdf shall <br /> p:InPormW af: (� e�e purpo�e and�a�ended v�e of ihe esquesmd der�wimfD die eollocdng 3t�tc�cary�F°l�n�l subdivlsion.0�9nlCWidO 3y/3Tem; <br /> �)whe�bmr he m�y rel�se vr la legaAr requind�e�pply me�equeseed lan:(a)se4Y i�owa eom�quenae arblag imm hl�supplywg ov re[us���o s�spply <br /> pdvara or cenridendzl dam:u+d�d)�►r�de��ty of onc�r persoes or enders auc�erized by s�arc or fedcral tsw�o roceive thc d�u. Thts taCu�nmeat abill <br /> noi apply whcn�n indivldual is uk�d:o supply usves�gsdve dam.pursuan�oo secQon 13.83.subdl�ision S,m a law ee�fereamea�offke�. <br /> co ' 1onnT �enu v Iac nodc auired nEt�dti5 xuDdivision in d1e indlvlduRl income ot Pr�pc1TY Gz rchimJ <br /> �tNCUO 1��1SE�a °��j e fo � <br /> Subd.3, Aeeess co da�a by indtrfduaL Upon rtqurst ra�responsbl�au�Lorip�.an iadividuil shall bo ir�fo�med wha�hec pe is�he subJeCt <br /> o�swted dsn on iadlvidusls,asid whcd�er i�is�lsaslfi.cd s.s Wb11�, pnvata or conFder►daJ �h�dN�he Qesues,sha��vifttotmed�of cho cantcnc <br /> o(y�p�bd privsce or publla dam on iadividuals fhall bt ahown�e dap.u+idtou�aay chsrg <br /> ind mr.aui�a8 ot�h�a'a. Atur sn individu�!has bcen rbown tt�e priv�re dan�nd lnforrned of ir9 maaoi�oy.�dara aeed ont be d�sclos�d w hlsn for <br /> ii�mon�s ducsaEzc[unless a d'upu�e or ecdoa pursuane�a rhis secdon is pondla�or addiaonnl dau oa ehe individ�al 6at bern collecoed or aeaied. <br /> 'It�e[�sponsble au�lsoriry shaU provPde eoplea oF che privare or puDlic aaa upon rcquesc hy�hI iad►vidual Rbj���o!►he dt� 2he resPonalble aurhodry <br /> may require d�e ft4uespng DdrsOn to pay du aeeual eosrs of maldi►B.eerdfyln��and wmpUing die eapiel. <br /> '[he responstDla su�horiry she�t compRy iminedia�elY,if Pai►�b���w���lY�4ues�made putsuanl m�hic suDdivision,or witdUf f�ve days oF <br /> r.he dgu ol�he rsques�,cscludlag���day9�Sundaya asd te8sl holid�ys,i!iramadiate compliaaea Is oocpess�l�. IP he csnaoe complY wid�d�e reques� <br /> wGhin�hs�dmz,he shaU so infvrca eEe individu�l.and may 1+�ve aa addidooal llre days wi�hin whlch�o aomply with the reQu.a�exdudiaQ Saardays. <br /> Sundays and IaBsl 1t01idyy�. <br /> • gyy�,q. prooedai e yrhen 4nta t�not aceura�e or eompku. An iudiv�dvel may conn�a►e accuiacy or aomplemaess o[publ�ot pri�•ace <br /> dan co�rning hirnselE. To ex�eetsc d�is rl�ti4 es�+ndividw�l shnll aoc�iY in wrideg�he rzspoeaible au�ociry dacsibins�he aawra at�he di4agzsemep�. <br /> 2'�e responsible au�horiry ih�U wirhia 30 dsys ei�st: (a�conra @�t�a foued eo De Insceu�ate or tncnmpleoe sad oatmp<<o norify pas�ren}pien�ol <br /> tanccuraR ar Incomplaa daca, ineiudiag recipiaaa oamed by�e indlv4iuel;or(b)noufy drc irvli�tdunl�hac he bd'uva�e daw w 6o corsee� Dsn <br /> l�dispu��ahs11 be d;scl�eed onJy l!�a ixli�idual'� suiemeoc ol dlsa��ceeraen�v icu3udad wah tD�disclascd dao. <br /> Thc docezrninanon of�a resporuible Au�hnrih may Se ap�•ajled pursuaac�v che provie[ons of du admlais�ari�e procedute acc re��ia8 to <br /> eontsstad rases. - , . , <br /> D�PRNA�Y ADVISORY <br /> I►1 sccorda�cc wirh M,S. 13.04,5ttbfl.2, "Ri.�hts of,ubjec[s of aa�a',we would iike so inform you tbat your request <br /> for a permic or licen'a from the Ciry of Orono oz any uf it9 deparemeacs may require yau to furnisb cettain priva�a or <br /> confideutisl.information. <br /> You are nociFied tha[' <br /> 1, The inforcnatian yoa furnish will be u5ed�o de�emtine your qualifacauon for iho permiz ar lieense requcsted. <br /> 2, You may rctuse to supply data, but refusal may requiso �haz the City deny the permi� or licease. <br /> 3, TDe infoima�ion may be shared wirh ocher iocal, sca�e or federal agencies �o the excenc aeccssary to process <br /> rhe permit or lteease, <br /> 4. It your requeaud pecmit er liaense requires Councll action co epprove, some iaformauoa mtty beeame <br /> publie. <br /> S. You have �enaln rights undet M.S. 13.0� (available upoa tequasc) ce review priva�e data on yourself. <br /> fi. Your full neme is requiz�d ea process thii applicacion or pecmi[. � <br /> ��� dd�drlle ^ � Lasc <br /> Address , <br /> Ciq T Sore Zip Phone . <br /> i uude d a�y rleh�s as s�aced above. <br /> • CU�t�/'4cto� <br /> Sigaature <br />