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Ju1-18-2001 11:48am From-CITY OF ORONO +g522494616 T-436 P.002/002 P-970 <br /> � <br /> � Scc.I3.0-t R.IGf�fS OF SL'BJEC?S OF DATA <br /> Subd. l. Type oP daea, �e rights of individual oa wham t�e dan i�stor�or w be scnred sball be as sec focsh in dzis gecdan. <br /> Subd.2. Infocm�tion reqidred to he givea(ndivfd�nl. ,�n;r�i�;dus7 askcl ta supply privare a�conFdcodal dsa caacerning himself sh�1� <br /> be informed ol: (s)che purpose and;ntendcd use oF[he requesr�d dan w:#in�he eolleedag§c3te agency,polidcsl svhdivis;oo,or sratewide rysrcas; <br /> (b)Whec�er he may refuse oY is lec,a[[y�equir�d�o supp(y the�equested d3.c�;(c)any Icown eoasequeBee adsin�r from his supplying or refusing m supply <br /> pri+ace er eonndendal dacz;ar.d(d)�t►e idenriry of oUicrpersoas orenno:s a�chacized bv sc�te or tederal taw�o roceive che da�..'fh,is rcquircmen�shal► <br /> no�apply whan an ir:dir•idu3.1 is askcd tn ssypiy invesdgarive da�,puts�.:c�o seccon 13,82,subdivisioa 5, w a law caforeemea�officer. ' <br /> The co 'ssioncr oF revenuz mav olsce�he noGte r�auired �rd-�Chis subdiv'sion in dte individual income tax or proaet�tv�gx Pefurtd <br /> �sccvuions insread oP on rho�e Forms. ' <br /> Sabd.3. Acce.�to data by indisidual, Upon tequcst to a�r,.ansibla au�oriq/,an irwdiv�dual shall he infoRned whethc�hc is rJse subjec� <br /> of s�nred daca On individuJs, and whc�hcr i�is e(assifiad as pubiic,privae or conhdecrial. Upon his funher requesc,aa indi�idusl who is rhe si:bjec� <br /> of srorcd priva�e or public daca on individuals shall be Shown[he dan wiu out usy t"osrgc to him end;iP he desires,shaU be informed of rke coacen� <br /> and mesning of clt��dscs. Afur sn individual h�been shown che priva��a and ie.'araud of i�s meaning,the da�peed uot be disclosed W hitn for <br /> six eion�hs�hereai�cr unless a dispute or acrian pursuan�W chis secdoa is yeading or addidan�l da�s on�he individusl has been colleued oc creared. <br /> 'ihe tespansiblt au�horiry shal!pro�id�copics of�he privaee or pu�lic dara e�an reqla:by chc individual subjecc of[he dars. Zhe responsible auchoriry <br /> _ msy rcqaire�he rcquesring pecson ro pay che acn�al cosrs of m.gking,cc:,�ing,and eomp�ing�hc copics. <br /> T$e�CSponsible su�llocicp Sh111 Comgly%m.rrw3:acc;y,i.Fpus�ioi_,wich auy r:ques[mado pursuant eo[his subdivision,arwi�hin�ive days oF <br /> �he dsce of ihc requesc,eccluding 5a�urdays,Sundsys snd legal holidays,i7 ir..medi�ce compliance is no�possible. IFhe cannoteamply wieh the�:ques� <br /> wi�hin thac cme,he shall so intorm�he individual,aad may have an addi�c=.a1!ve days Wi�hin which ro comply wi�h the request,cxoluding Sacu�days, <br /> Sundays and lcgat holidsys. <br /> Subd.4. Procedure whea dsta is not accurate or compl�te. An iadivi�u.1 may cocuesc�2►a sccurscy or comple�eness oF pubtic or pri�•ace <br /> daet conaeming himself- Te exe�eise chis righc,an individual shap noai�ia wtidag�t respoosi'ble authoriry dascribiag the nan�re of the disagsti:mea�. <br /> ' �e responsib[e auchariry sh31I wiehin 30 days eiihcr; (s)corr.cr�he dae rcond co Ee insccun�e ar incomplac and aacmpc ta nodfy past cacipienrs of <br /> inaccursce oc incomplece dsrs,includ�ng rccipicn�s named by rhe indiv;d�l;or(b)�odfy ehe individual tha�he 6atieves die ds��o be coacc�. Dar� <br /> in dispu�e sh1fl bt disclosed only;F the individual's Sracemen�of disagr=��=nc is�.el�dtd wi�tt�he discloscd da�a, <br /> Tlie dzcarmin�aon of�he responsib(e auehoriry may be appes::d pursuscc co �Ae provisions of ihe sdminisaarive procedure ac�rd�nng�o <br /> conms:ed cases. . • � . <br /> DAT�, PRT�t�aCY AD�"ISORY <br /> Tn accocdance wirh M.S. 13.0�, Subd.2, "Righcs of su�jects oi�a�a", we would like[o inform you tha�youc rzauesc <br /> for a permit or license from the Ciry of Orono vr any os ia depar,�en�s may require you to fumish certain priva�e or <br /> conFidencial information. <br /> You are notifed that: <br /> 1, Tize informa�ion you furnish will be used to de:zrmine ti-our qualiFica�ion for�hz perrai�or Iicense reques�ed. <br /> Z. You may refuse to suppty data, bu�refusal may require that the Ciry deny rhe permit or licease. <br /> ;. The informa�ion may be shazed wich o�her loc�l, s�a�e or federal a�eacies to the exten�necessary �o process <br /> � �he �ermit or license. <br /> 4. IF your requested pecm.it or licease requi�es Council ac�ion �o approve, some iaformauon may become <br /> . , pubTic_ , � <br /> �. You have ceRain ri�hts under M.S. 13.0� (z:ailable upon requesc) co rcview�priva�e daca oa youcself. <br /> 6. Your full name is required �o process �his aoplica�ion or pecmit. . <br /> Firsc yiiddlt Las� <br /> �: <br /> Add�css <br /> Ciry Sn�e 2ip Phocu . <br /> I t�fider d y ti� t te� sbove ' <br /> ;_ � � <br /> Signstuce <br />