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� � Sec.13.04 RIGHTSOF SUBJECTSOF DATA <br /> �d.1. Type of dafa The rights d i ndividual on whom the data is stored or to be stored shal I be�set forth in this sec�on. <br /> SLbd.2. Ir�formationrequiredtobegivenir�vidual.Anir�d'ividualaslcedtosupplYprivateoroadidakialdataoaioarrnghirr�selfshallbe <br /> iMortnedof: (�theptxposea�dirtaideduseofthereqi�teddahawithintheodledingststeagawy,polititxlsdx6vison,orstatewides�stem;(b) <br /> whether he ma�r reFuseor islegally reqiired to�pply therecpiested d�(c)arry known oonsequaioeaisng from t�ssupplyir�g or r�us ng to supply <br /> privateoroaifideitiaid2t�ax1(cntheidattityofotl�pesonsorenfitiesaAtnrized6ylateorfederallanrtorecevethedata Thisreqiirernentstrall <br /> not�ply when an in�vidual is�lced to supply investig�ive data,pur�ant to saction 13.82,s�dvision 5,to a law eiforoar�ert�oer. <br /> The corrmiss+oner d reverxie mav daoe thenotice reaired tx�this sibdvison in the indvitival ir�cometac or oraoatv tac reFtmd <br /> i nstructions i rutead of on Uiose forms <br /> SLbd.3.Aooesstod�abyindvi�al. Uponreqt�esttoare�auidearthority,aiindvidualshallbeinfortrierfwhethaheisthe�jectof <br /> storeddataonindviduals,aidwhetheritisdasafiedaspublic,privateoroonFidartial. Uponhisfurtharec�est,anindviduaiwhoisthesibjedoF <br /> stored priv�eor public data on ir�viduals shall be�own thedatawithout any diageto him and,if hede�i res,9rall be infortned o�theco�ent and <br /> rrieaningo(th�data Aftaanindvidualhasbeenstqwntheprivatedataandinforrriedofitsmearrng,thedafaneednotbedisdosedtohimforsix <br /> monthsthereeftauNessadsputeoractionpirsia�ttothissectionispaicfir�oraddtionald�aontheindvidualtrdsbeencdlededorcreeted. The <br /> respaisblea�thaitysMallprovidecapiesoftheprivateorpublicd�auponrequestbytheir�d'ividualsubjectofthed�a Therespa�sibleauthority <br /> rr�requi re the reqi�e5ti ng pason to pey the actuai oosts d rrnki rig.oertifYi n8,a�d carpil i ng the oopies. <br /> Theres�onsWeaithority shall oortply irtrnedately,if possid�with ary rec��x,t rt�ade pu�uard to this�vison,orwitFanfiveda�rsoi <br /> thedateof the reque3,ecdud ng Sahrdays,SLndaysand fegal hol ida�s,if irmiedateoort�lianeisnot possde If hecariot oorrply with therecµ�est <br /> within th�time,hesh�l so inform theindvidual,and ma�havean addtiaial fiveda�swithin which t000mply with thereq��est,ecdudng Saturdays, <br /> S�x�daysand legal hdidays <br /> SLbd.4. PYooed�rewhe�dataisnot aoar�eor oomplete An indvidual rrra�omtest theaoarac�r or oortplete�essof qblica privatedafa <br /> �ninghi►r�self.ToecacisethisrigM,aiir�vidualshall notifyinwritingtherespor�.sbleaAhoritydesrridrgtheretureaFtheasagearent.The <br /> responsiWe aRhority sMall within 30 dayseither: (�oorrect thedata fand to be inaoauateor iraarpleteand attenpt to notify past recipiQntsof <br /> inaa�rateorinoon�letedata,indudngrecipartsnanedbytheindvidual;ar(b)notifytheindvidualthathebelievesthedatatobecorrect.Datain <br /> di�ute�all be disdosed oNy if the ir�vidual's statanait of�sa�rear�t is induded witfi the�sdosed�ata <br /> Thedetamir�ation d therespor�sible aithority may be�peeled p�rsva�t to the provisionsd theadministrativeprooed�react r�aati ng to <br /> oontested cases <br /> DATA PRIVACY ADVI90RY <br /> I n a000rdaioewith M.S 13.04,SLbd.2,"RightsaF subjectsoF data�',wewa.ild liketo infam you that your request <br /> for a permi t or 1 i cense from the Ci ty of Orono or ary of i ts departmaits may req�re you to f�xni sh arta n pri vate or <br /> oonfidential irrformation. <br /> You are r�tified that: <br /> 1. The ir�formation you furr�sh will be used to d�amine your qualification for the permit or license <br /> rec��ested. <br /> 2. You may reFuseto supply data but refusal may requirettrat theCity deny thepermit or licens� <br /> 3. The inFormation may be stiared with other local, state or federal agaicies to the extent nec�say to <br /> prooess the permi t or I i ce�e. <br /> 4. If yau requested pemit or Iicense requiresCouxil action to approv�some inFormation may beoorr�e <br /> p�l i c. <br /> 5. You have certan rigtrts under M.S. 13.04(avalable upon request)to reviaiv private data on yourself. <br /> 6. Yau ful I nar�e i s requi red to prooess thi s appl i cati on or perrrit. <br /> -�h�.�.„ ; -:1� l�, t��--, <br /> Fi rst M iddle Last <br /> / �'�`�� ��� /�� ��,c— c'���' <br /> Addre� <br /> f�-%� ,�.v �� `�`3 � ��l-�'�'�� 3 z <br /> .�,- �� <br /> City State Zip Phone <br /> I understand my rightsasstated above <br /> , �.?� �.�� % <br /> �� <br /> Signature ' <br /> Sf tf�C�e� 32 <br />