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C�� �?5� -� �G9- S��/� - <br /> . � <br /> Sec.13.Q4 RIGHTS OF SLTSJECY'S OF DATA -- - • � <br /> Sutd. i. Tppe oI data. T'he righct of iadividual on whom the data is scor:3 or ro be smr:d shaIl be u sec forch in chis setrion, <br /> ` 5u�d.2. Iatormation reqtrired te be givea iadiriduaI. An iadividuaI uked to supply priva�or eonfideedal daca eoaceming h�r�,c��s�,n <br /> be ia,ormed o,: (a)the purpase aad inc:ndcd use of the rtqu�dan wic4ia the eolIecdng 3�c:agecey�poliricaI sutdivisioa,or scimw?de rist�• <br /> (b)whe�`.e:he r.3�r.Fuse or is.le3aily rquir_d to suPPlY.the rquesc:d dati:(cj aay f�owa ea��quccce arisia3 from his sicpplyiag or refusiag tc�suppiy <br /> privac�or eo:i::d:r._sI dat3;a:.d(�t�e idenary of a�erpccsoes arecrides auc�orized by snc�or F:�e_':_a:�r_c:ive the d3a. This r_quircceat s�='I <br /> not a�piy w:.ea art i.dividuaI is uked to supply invudgadve daa.pursuaat to s<cda¢13.82,suMivision 5,oo a Iaw enforcemert o�cer. .. - <br /> 'Iha ce:zmissioner of rever.u� mav tace.che rtodce te�uir_d urtder this sutdivision in the ir:dividual ir.come e�x or orooectv taz teFur.d <br /> inmucaons i.�sread of en chose fornu, <br /> Subd.3. Aee�to data by iadiridual. Upan requesc co a czsponsible auchoriry,an'mdividuaI shail be informed whecher he is che subjeet <br /> o!s2orcd dan on individaaLs,aad whe�her it is etassiFied u publie,privat�or eoaP.deaaat. Upaa hu fur�her r_quest,aa iadividaaI who is the subjecc <br /> of stor.d Qriva�or public daca on iadividuals shall be showa ehe daa wichaut nny charge ta him and;it ha desiru,shali be infocmcd of�e eaaceat <br /> and m:aniag of�at daea. Ahet an individuaI has beea shown[fie priva�.dae ar.d informed o[ics meaaiag,the dam ne:d not be disclosed w hica far <br /> siz mondu ther_afcer un]ess a d'upuu or acaon pursuant W this secdan is p<nding ac addidooal dac�on the individual has been eollecc:d ar ercat-,d. <br /> The tupaasible aut2:oriry shallprovide eopies of che privace or publie daa upon request by rhe iadividual subjecc o[che daa. Tne respoas4ble auehodry <br /> may requir_ che r.quesdng person to pay the acata!cosu af ma.'cing,eerrifying,acd eamp�ing the eopia. <br /> Ttie responsible auchoriry shaIl eampty imrardia�ety,if Qossible,wieh aay tequat ta3de pursua.nt ta �his subdivision,ac wichirt five days of <br /> the da�:of ttse rcqc�esc,ezciuding Samrdays,Sundays and legal hoiidays,if ir,unedi��e campliacce is notpessibte. If he c3rsaot eompty with the request <br /> wichin that dace,tse shall so inforra the individual,and may have an addidonal five days witfiin which to compiy wich the requesc,ezciuding Saeurdays, <br /> Sundays�nd IcgaI holidays. _ . • <br /> Subd.4. Pracedure when dsta is not aecurate or eomplete. An icdividual may eonc:sc che accurdcy o�eompie�aeu alpablic orpriti�ace <br /> dara conceming ticroself. To ezercise�his righc,an ir.dividuaI shaIl nocify Ia wrida�die r_spoasble auchoriry descnbiag the Qature of the d"uagreemeac <br /> The respoasible auehoriry shall wichin 30 days ei��cr, (a)correct rha daca Cound to be inaccurar�or ir:compiem aad accempc to aodfy past recipiencs of <br /> ina;curace or incomplete data,including recipica�s narssed by�e individu�l:o�(b)coafy the individual thac he believes the dati to be correcc Da� <br /> in dispace shall be disctosed onIy if�he individual's scacer,senc of disagreemeat is includ:d wirh the disdosed daca. <br /> The de�crminadon ot the responsibte auchoriry may be appealed pursuanc ro the pruvisioas of tha adm.inisaaave procedum act retating co <br /> eont�s..d cases. � . . . <br /> DATA PRTVACY ADYISORY � <br /> In accordance with M.S. 13.04,Subd.2, "Ri�hts of subjeccs of data",we wouId like to inform you that youc request <br /> for a permic or license from the Ciry of Orono or any of ics depanmencs may require you to furnish certain private or <br /> confidential information. <br /> You are notified that: <br /> 1. The informatioa you furnish will be used to determine your qualification for che permit or license requested. <br /> 2. You may refuse to suppiy data, but refusal may require that the Ciry deny the permit or license. � � <br /> 3. The information may be shared wich ocher local,state or federal a�encies to the ettent necessary to process <br /> t�e permit or license. ' <br /> 4. If your requested permic or license requires Council action to approve, some informatiou may become <br /> . pubiic, . . - . . . _ . . <br /> �S. You have certain righcs under M.S. 13.04�(availabie upon request) to review private data on.yourself. . . <br /> 6. Your full narae is required to process this application or permit. <br /> - - ��Y l�� L.I Y1 �I CJl'1'l . . <br /> Firsc • , n �[iddle �t • <br /> GI �� 1 �1 'k-�C.� . <br /> . .�aa ,_..... ... <br /> � � � � � � VY� 1�-� ��5 3 � � ��3 �) ,3�(-��l� �� - <br /> Ciry Scue Zip hoae <br /> 1 stand my riQ as s ted above. <br /> G % • <br /> � , <br /> �'��"' -2 L� ��')/''� � <br /> signacure <br />