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Dac-18-2001 �3:3Tpm From-CITY OF ORONO +8522494616 T-377 P.003/003 F-527 <br /> .. <br /> � Sec.13.04 RIGKTS OF SLJBlECTS OF DAT.� <br /> Subd. 1� Typ�oe da�a• Th�^81��oP individual on whom�hC da[a is srored or�o be s�ored shaU be as se[fotth in ihis secuon. <br /> Subd.2_ Iaformatioc required�o be gi�cn fndividual- P.n individual asked W supp�Y PnvnrP or confidcaual da[a caacctvia8 himstlF sha11 <br /> be infvrmed of: (a)[he PurPose aod inrcaded us�of nc�rsqucsu�da�t wi�h�n rhC collecdng Srarr agency,polidGal subdivis�on,or s�tcwidc sysum; <br /> (b)wherhen c�may rcfuse or is IeEallY raquircd to supply nc�requcsred dats;(c)any�e+o+vn consequeace arisi.ng froin tiis supplying or refusing�o supply <br /> privar�or confidenp�l d��:�d(d)�he idenriry oC onc�r prrsons or cnric�s authorized by s�ace or fcdecal law co t�ceive rh�da�a. This requiremcn[shall <br /> noc 3pp�y whon an individual is askcd�o supply invesdganve daa,pur!usnt�o sccdon 13.82, subdivision 5, �o a laa onPorcemee�officer. <br /> '�e comritiSSionBf of r�vcnue muv D�Bcc che nocice reauirej under thi� 5ubd�viSfO� �1'� �1a �ndiyldua� illcomC Cax oc ro 2 taX Tefund <br /> Grt5[Nc[i�I1S L[15[e1d of on chose ��3� , <br /> Subd.3. Aceess to dat�by'v►dividual. Upon rcquesc to a r�sponsi6le au[hority.3n individual shall be informcd ahethen c�is�he subjec� <br /> of scored data on o diUbl e,dara on nd�v du�ls shall be shown the ds�`wi�hou�anya na s<<o h�ana�i�z d�sir�st hU ba infoen doof[he con�ene <br /> of s�orcd privac� p rhe dara need m�bc disclosed oo him far <br /> and meaninS of�hac dara. AfrCr�n irulividual has bcen shown�he priv,�co da[a and inlormad of i�s mcaniag, <br /> siF monchs�hce��ori�cshal!prov de copceoof theSpnvace or�public d:�ra pon rc4oes�bY�[he indiv dusl subJec�of the dar,a-bTho z spor�s bleraurhoriry <br /> Thc respon�ibl �5' c�pp{y�nS,a�compain�t3�capics. <br /> may tequire rhe requssdng person ro paY�e actual cosrs of ma7ci»8• <br /> 'I7�e responsible auehoriry shall comply uNn�d�a�ely,if poss�6lc,wich anY rcquest made pursuanc to rhis su6division,or wizhin fivo d�ys o <br /> thc da[c of rho�equcs�,ezcludins Sanirdays.Sundays and Icgal holidayr�,iP immedia�complianec is not possibtc�i��c cRIIuest mxcludi g Snturdays, <br /> w�r�,in rhac timc,he shall sa infocm the individual,and m�Y have an ad<liuonal fi�e days wi[hin which[o cacuply 9 <br /> Sundays and legal holidays. <br /> $ubd.4. Ptoeedure when d�ta is oot aecurnte or comple�.o. An individual may contes�rtm accuracy or complcceness 4F public or pn�'a�c <br /> asc rcci ienss of <br /> daa�oncerning himseif- To cxercise this�Sh[,an indi�+dual shall nodPy in Wricin6�a�eponsibla au�horiry dcscribins�e na�+�of�e d�sagcecmen�. <br /> 'Ire responsible au�horiry shall wicfiin 30 dsys ei�her. (3)correc[the da�found w bz it�accura�o or incomplete and sacmpe w nodtY P p <br /> i�ttccu�a.r�or�KamP�e�c dara, ineluding recipicn�s named by �tx individual; or(b)nou(y the lndi�idux7 chaL hc btlie�cs rhe data co be coRcet. Dara <br /> in dispucc shall hc disclosed en1Y �f�he individual's seacem�nc°b�daal�e3lcd�pursu�'w iha P°v�i°�s of r,hc adaunis�r�av�proccdure acc czla�8 � <br /> Tl�e dccecm�nanon of�hc rtsponsiblc au[horicY may PF' � <br /> conttstcd cssc�. <br /> DATA PRI'�'A.C'Y AbVISORY <br /> In accordance wi[h M.S. 13.04, Subd. 2, "Riah[s of subjects of data", we wouJ.d like[o inform you tha�your reQuest <br /> for a permic or license from �hz City of Orono or any of i�s deparLments may requixe you �o fumish certain priva�e or <br /> confidential information_ <br /> Xou are no�ified that: <br /> 1, 'Ihe infocination you fumish will be used i o determine your quali�'icatioa for[he permit ar license requesced, <br /> 2, You may refuse �o supply da[a, hu[ refusal. maY Te4u�rc that the Ciry dcny the permi[ or license. <br /> 3_ The infvrmation may be shared wirh other local, s�a�e or federal agcncies [o the extenC necessxry to process <br /> :he per:nit or license. . become <br /> ,�, If your reques�ed persni� or liceuse reql�ires Councii ac..or. *o a^rFrov-• somc informacion maY <br /> public. <br /> g, You have certain rights undet M_5. J.3.04 (available upon reques[) �o review priva�e daca oa yourself. <br /> 6, Your full name is tequired �o process �t�is applica[ion or pe�nit. <br /> �T'o c. � S, /�y s-�ro n-, <br /> Middlc Las[ <br /> Firs� � 7$/� ��-�e. 6 T V � �� <br /> LJ /l'L/� S..S3 7 3 ��3 Lf 7 7- �f l9 � <br /> Addro6s� � /� �„ / <br /> Q rD Q S�Ce Zip Phcne <br /> C1ry <br /> I underscand my rights as stated 3bovc. <br /> � " <br /> Signa[urz <br /> 12/18/O1 TUE 15: 36 [TX/RX NO 5051] <br />