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��u �F �RGMO � ��24��05�� �9I24/96 14:00 �1 :03/03 N0;52� <br /> ,. .. <br /> Sac.13.04 RIGI�TS OF SUHJEC'�S OF aA'i'a <br /> Subd. 1. Type aP dsts. 2Re eiyh�s of indlveduai o�1�2tam dte data ie srored or ro be scored shall be sx set fotth In thIs seedan. <br /> Subd.�. Inlorpeatlon req�red qo ba gtren lndieidu�l._M Individual askod ro suppiy privece or oonfidenaal d�n cancernlr�g�imaetf ihall <br /> be Inlormed of: (v)dte purpose and inunded use oP fie pequesued d�m+virhin the wllecdnQ snte ageacy, polldcal subdiYision,or stsro�vide system: <br /> (by whether he may nfuse oT is Iegtlly requited m supply rhe roqu�ased dau;(c)�rty fcnown eonsequeai:e arising from h9s supplying or mAtsing ro supply <br /> priva�a or coaPidenci�[data;and(d)�e�donriry of od+c�person�or enddes aurhorized by suie or Pederal I�w m rec:nive the da�a. ThLt reqviremene 5ha11 <br /> noe apply when an individuel is eskeJ eo �uppiy lnvesrig�dve dais,pursuan<<o cecdon 13.�2, subdivision S,to a law enforcemenc offker. <br /> �n cs��i s_ignCr 2f ro�enue mav lace ihe nopce s�quired under chis subdiYisiQn in ttee individu�l income rax or oroosm mx:nlSind <br /> ` j{�tt�cdona{�sceud of on�iaso forma. " <br /> SuDd.3. Aceeea to data by 6ndlvidual. Upon roques�to a �espansible aurh�nry,�n iadi�iduat shall be informed whether 6e le�he s�tbJeec <br /> ot�wred dau on individuals,and whedfar ie is elassified as public,priva�e or cvnPidendal. Upon his fturher�ues[,an 9ndividual who i�rhe subjzct <br /> of seorod pn�au or public daw nn individuals shall be sho�+rn�he dara wi�houc any char�e w him nnd:if he dealres,shefl be infotmed of rhe conCenc <br /> rnd meaning of d�at dam. Aher�n imiividus!hu been shoWn the pti�ete dQra and infomxd of i��eaning,the dau nand noc bs diselosed w him far <br /> �ix aionrhs thereafur unles�a dispute or�ecion pursuan�ao ihis:eedon is pending or addi�onal dam on the i�dividual lias been eullecced or created. <br /> The mpunsible authpriry ch�ll p�o�ide copies oP du privare or public dara upon reqvesc by the individuat subjacc of rhe dara, The re�onsible aurhoriry <br /> may requiro rha requearing person ro pay ehe x�;ael cosu of making.csrtilyinQ.and eompilfag rho eopies. <br /> 'ilte�sp��nsible auth�riry shall comply imrt'►edi�taly, if pussible. aith aay request made pursuant m d�is subdivision,or withln fi�e days of <br /> che date of the;equest,excludin¢Satutdays.Sundays ond Iega[ho�ldays,if immedlue compliance i�not po9sihle. INhe cartnot comply with rhe roques� <br /> wlthin du�dme,he ahall su inform rha indiv9dual,and may ha�e an addlrional five days wid�in which co cornply w1�h the request,excludlpg Saa�rdays. <br /> S1�mleya and legwl holldays. <br /> Subd.4. Ftoeedure ah�n dnla is net accurate or rnmpltte. An individuol mry conusxi�h�accuracy nr compluenos�of public or privu�e <br /> det�sancarn�n�himself. To exarcise rhis right,Pn indi'viduel shall nofify u wridno�ke responsible auehodry desetibing d�a nemro of rhe dlaagreemcnc. <br /> The soApona161e authoriry d�alt withitf 30 days either: (a)conec�the dam found to be inaa�rA,te or ineumplete and attempt to n�lify paie recipients eE <br /> inaeeunte or encumplete dpra, (ncluding recipiencs named by tbe individual;or(b)nodt�the individuat thec ho belleves the dara eo be corree� Dam <br /> ia d�spuce ahall be discloaad only if the indlvidual's sm�emenc of dissareem�►c is included wirh the di9c9osed dara. ' <br /> '�'he doterminntion of�he responsible eu�lioriry may bo appealed pursusnt to th�pro�isionc oP itte adminiserative proeeduro tct reladne w <br /> wnmsted cmees. , <br /> � pAT���A„CY ADYISO�Y <br /> In�ccordance wich A�Y.S. 13.04,Subd.2, "Kighcs of suti]ects af data", we would like to inform you that your requesc <br /> for a petmit or ticense from the City of Orono or any of its departmencs may require you to turnish certain private or <br /> �onfidential information. <br /> '�ou aro na[ified tha[: <br /> 1. The infocmatian you fiarnish will be used to determine your qualiftcation for the gcrmit mriicense requosted. <br /> 2. Yuu may sefuse to supply daca, but refusal may require tha[ the City deny the permit or license. <br /> 3. The inFormation may be shared with otbcr local, state or federal agencies to the excenc necCasnry to process <br /> the pecmic or license. <br /> � 4. . If yout requeeted pecmit or licease requires Cmvncil action co app�ove, some infarmation may becomc <br /> ' public. <br /> S. You have certain righcs under M.S. 13.04 (available upon requcst) to reeiew private data on yourself. <br /> 6. Y�ur full name is required to process ebis application or permic. <br /> ., . . <br /> . � � ���� �� �� � <br /> F'�t� �` � � Mlddle Last. — <br /> ) ���� � ;� � � � ���... <br /> a � �>� ��`�[� 5— ��� <br /> �y, Soce 2ip Phon� <br /> ' i•uaderstand my ri�ht staced above. � <br /> Si�na�u�e <br /> D,.,._ .....7 mf. n n� . �nn�r n. . i in, .. .. . . ....... <br />