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-� � -�� ��•»�N�� n um �ii� ur vRunu +8522404616 T-4A0 P.007/OOB f-59Q <br /> ' �ec,13.Od RIGHTS OF SilSJF,CTS OF DATA <br /> I SuDd. 1. Type ot data. YTu rignd of inJividual on whom�he d�n ts scorcd or to be�forcd sh�ri bc u sct fonh 1a chis sccc;on. <br /> Sl�bd.2, Iafornu�tioa rcquired to be pvco individunl. M In4iv1dui11skcd N Supply privcce ot confidcnriai dra conceming himsetf <br /> sh�ll De informcd af� (�)the puepose u�d inrended use of fia requasud d�u wishin�he collecring suta agentY.policical n�bdivision.ur sa[ewide <br /> syskm:(D)whether he may refute or is Iegalty requittd to sapply ehe reqvesrcd daa;(c)�rry{auwn eoruequrnee arising from his ripplying or <br /> rcfvzing rn supply private or confidcnrixl d�u;and(d)ehc idrntiry of other pettom or end6es iu�hoiiz�d by state or Ccdcnl hw w rccoivo thc dxn. <br /> 71�is requiremen�sn�ll noc apply when tn indiv;dual is asked co suppty invicetig�iivc den,pursuant m ttetion 13.82,subdivis;on S,m a tzw <br /> entorccmcnt officer. <br /> The commis.inner ef re�emie mav nlnce fie nae�c'n�rn�ir������...�.:�q�������������������y����mt Ma or nrorxrtv tax� 6��A <br /> iesin�eri�n.incfeed of on�ho6e fe•ms. <br /> Subd.3. Aececc to dntn by lndivtdual. Upon reqnest w a resPotuible tutheriry,of�indiridunl chall De in(ormed wherner Ae is p�e <br /> suDjecc of seoreG dsw on individuils,and wherher ic is classifioA ns public,privute er conf,derui�l. Upon his funher requesr,an individual who <br /> is the eubjcct oE s�ored privnre or p�iDlic daq on individualt sDall be�hown the dou widbut xny eAatge[o Ilim and,ft Ae desfreJ,shall br InfomM! <br /> of tAe content ond meanirtg of diat dau. Ahtt�n indivjdual h�s bcen Shown drc privatt dant�tul informed of i[t maaning,�he Caa need noc be <br /> Cisctosed eo him tor six mon�hs[hcn�Rer unlen�dixpuee or accion pursuent to dils sectfon ts pandlag or�ddittoml d�[a on thc individuil Ans bcen <br /> eolltc�ed or creaud. The raponsible oudwTiry sha11 proviQt copiec o(the prlvue or puDlle din np�n rcquett 6y the indiridunl cubjea of�!u daa, <br /> The re5ponsiDle iuthotlry muy require�he reques[ing penon co pny�he acN�l cosa of mnkir�,ccr�iry;ng,xnd compiling die copies. <br /> Thc responaibte aueAoriry stull compty immodiately,it possible,wieh any request made pursmmto[hls subdivision,ot witRin trve d�y: <br /> o(�ho decc of ehe reques[,excluding S�mrd{ys.Sundays end le�{hofidnye,if fmmediate compli�nce is noe possible, If he rannoe camply wirh <br /> she rcquesc widiln diic rime,he shn1l�o inform�he i�ividuat,nnd mey h��e an�Cdicfon.l Qvc d►ys wi�hin whieh m comply wirh du remiesc, <br /> excludins Saturdays,Subvys ond legal holidayc. <br /> Subd.s. Proeedure when data 1�not accurate or eomplete. An individual may canttsi che aecuncy or eompleuness of publie or <br /> privirc daca coneernlr�himsetf, To exo�sise�hi�righ�,an individn.l sh�ll rrotify in wriring rhe mponsible�uthotiry descn'bing d�e meure of d�e <br /> disrgreemrne. T1�e responsible�uthoriry Wd1 widun 30 days eid�er. (�)cotrect dte dan fosmd to te h�ceucnre or incompfete and�cre�pr to nodfy <br /> pu�recipiena of isucwnm or incomplem d�n,ineluding rocipienp n�med by rhe individunl;or(e)notit�r the indlvfQu�l du�t he believes the dao <br /> ro bo corttc�. Dau in dispu�e shill be diulosed oNy if�hc individusl'e cmtemen[of dis�greement ts includcd wi[h tAc d'uclo�eC d�u. <br /> ?1ie decerminadon ot tl�e re�onslble iuthoriry may be sppeated punurnt to tAe provisfons of the tdministrudvc procedure act rclating <br /> co conmsted tases. <br /> DATA PR1'VACY AnViSORY <br /> In aceordanee wi�h M.S. 13.04, Subd. 2, "Rights of subjeets of data", .v�would like co inform you chat your <br /> requcs� for a permit or Iicense from the Gity of Orono or any of its depar�ments may require you to furnish certain <br /> privace or confidential intormation. <br /> You art notified that: <br /> 1. Tht information you furnish will be used to det�rmine your qualification for the permit or license <br /> reques�ed. <br /> 3 You may refuse to svpply data, bui refusal may require that the Ciry d�ny the permit or license. <br /> 3. 'Ihe information may be shared with o�her local, state or federal agencies to the cztent necessary to <br /> process rh�permit or licenae. <br /> 4. If your requested permit or license requires Council accion to approve, some information may become <br /> public. <br /> 5. You have cenain righcs under M.S. 13,04(available upon requcst)to review private datA on yourself. <br /> �.,__�.�^� 6. Your full name is required to process this application or perm�t. <br /> �r.��,����— . <br /> � _�S �C�� L <br /> � <br /> � ��,E� , �o�. —1 a�M,dd�� <br /> t:�' <br /> �'�"""`+�+. Address <br /> �-' �,����... YY1r�.• �:��31 �S Z �3-0�� ! <br /> r'�"� c�ti sau z.;p <br /> Phone <br /> 1 underst as scated above. <br /> SignaNre <br /> 6 <br />