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TY OF ORONO � 6124130510 09/24/96 14:00 � ;03/0� N0:�22 <br /> . . <br /> 3+ee.13.04 itlC,Ti7'$OF SIlB,I�CTS OF DATA <br /> Subd. 1. Type o(dats. 'rhe dybts o�iadlvidud o�1 whom the daC1 I�nored ot[o ba zmred s�all bs u ut forth in thi�ucdan. <br /> Subd.1. Inlo�atloa reqt�dnd to b��hen iadt�idual. M(adIvidud asked ro�upply privta or oonfideadRl daa conasraing himself,ahall <br /> be intotmed of; (t)tlta purpoce utd Inuaded uu ot du reques�ed d�p withln rhe wltecdn�ltau tgenay.polldeal iubdlvisloa,or�nro�vide syunm: <br /> (b)wi�ether M mar rafl�se oi ia leeally tequited co supply the raquesrod data:!c)�rty kaown eo�uequeaee aritirtg from hls eupplyln�or mtlisla�ro supply <br /> priv�u or coaMencL�I dra;and(d)�he idenriti o!od�e�person�or anddes�uthorized by w�e or tedenl I�w so rrxnive the dara. Tht�erqulremeAe�1w11 <br /> no[�pply when�n IndiriduU 1��sked w�npply Inve�rig�dve daa.pursuant ro ceedon 13.82, subdivision S.to�hw enforccmenc otncar. <br /> ,. � <br /> snm�t�{gna QP�ygrwe m�� alace du nacjce rew,�under this subdi�isfc�n ia �tse indlvldual incomc ax or�rouem rez�rolS'�r�,id <br /> -_" ��cdont iq�macl uE on�w�o form�. „ <br /> SuEd.3. Arcees W data by{nd[vidual. Upon rcques�fo a respurtsibk tutbo�ity,�n indi�fduaf shali ba Infotmed wheshar he b�he subjecc <br /> o[itoted dsu en ind(viduals.apd whachar ic is clusified a�publi�,p�ivi�e or canAde�xlal, Upon 6i�Nrther requett,�n individual who i��he subjact <br /> of uorod pri�ue or pubUo dw nn ind[vidu�l�shill be ahown ilu dan wirhou�ury chu�e w him rnd;i�he deslres,�h�ll be iafotmed of the conoen� <br /> al►d mMnlaa of d��t data. Aher on iadividual hai bean shown�I►e pri���e dua utid inCom�d of[u axanin4,Nu dau need not b�di�elosed to him for <br /> ds s�ondu tkcruEter uhle� a dicpuce or action punu�ne m �his secdoa is ptndin�or addirio�al dau on lhe indh�idu�l 6as been oollecad qr creaCed. <br /> 1Us rapontible autdQriq thall pm�ide eopiet uf rhe pmra�e or public d�a upon nequess br�he indlvidua!subJ�e�of the d4ra. The rcipons�ble�utAo�fry <br /> a+ay require the mquestin�p�rson ro pry rt�e actual cos�s�f makiu;.urtif�in�.�nd complUaa�he eopN�. <br /> Tha nesponeible wdwriry�h�11 comply immediately, ir possible,widt aay rcquesc medo purcuattt oo Wis�ubdivision,or aithln five days of <br /> d�s date of ehe raquee[,excludin¢9uutdays.Sundays end legd holldays,if imrnadlace compllance u not po��iblo. If�he ca�mwi comply wfth�he requesc <br /> witl�ln c!u<<Jmo,hv ahall a itU'otm ohe lndividual,aad may have an�ddlcioq�l flve d.y:wld�ln whlch co coroply,wldi t6e requeat,exeludlxu Samrdsys. <br /> 9vnd�Yi iod lepl holWay�. _. • <br /> Subd.�. Ptoesdun wh�n dn�a is net aceurst�or eomplste. An indlvidusl may eomeu tda ucunay or complereoos�of publk or privrca <br /> dia coacern�bimself. To exercise dus riQhL�n indi4iduel shal!notity in wddny the re�onsibk suthoc�4Y describin�d�e naeure of d�e AW�reethent. . <br /> The teipoarlble�uilw�ry ehdl within 30 days euher. (t)correcc the data found ro be uuca�nte or in�wmpte�e�nq�tumpt eo nodfy pue reeipknu oE <br /> i�aucate o�I�camplete dpn,Includin�rocipienu named by d�c individual:or(b)notifSr the individual that he belleves Iha d�ts m be oarract D�t� <br /> la dkpu�e ihall be d'ucloiad anly if the indlvidu�l's tuamaat of dlssareemenc Is tncludad with�he diuloud dam. - <br /> '�lie docerminaaon of�he responsible au�oriry may ba xppealed pursuaoi to th�pro�isio�u of du adminuaadve procrdure au ret�cin`co <br /> con�a�ted ea�es. <br /> � DA',�A PRNACY AD RY � <br /> !n accordanca with M.S. 13.04�Subd.2, "I2lghcs of tu6Jects of da[a', we would like to inPocm you that yourrequesc <br /> for a permit or lteenso from che City of Omno or any of ita departc�en[s may r�quire-you to fitrnish certaIn private or <br /> confidendal fnformation. <br /> 'f�ou are nattfied that; <br /> 1. The informetian you furnish wW be uscd to decermino your qual;ficuion for the permic or iicenae reques�ed. <br /> 2. You auy refuse [o supply daca, buc refusal tnay require that the Ciry deny the per[nit or license. <br /> 3. The informAtion cnay be shared wich o[har laeal, sca[e or fedeYal agenciaa to[4e extent neccssery co process <br /> the percnic or lianse. <br /> � 4. . Yf your tequaeted permit or llceuse requirec Council sction to appcove, some infatmatlon may become <br /> ' publtc. , , <br /> S. You have certain rights under M,S. 13,04 (avnilabie upan tequest) to review private data on youcself. <br /> 6. Ynur fult aame is requirod to process„this app]Ication or permic. <br /> . �l. <br /> � . F`�� a � , t� � Mcadi -� � [ � `"` <br /> � '� � -m+� �Szl C� � - vy - <br /> CJ�p Saie Zip Phofla <br /> � t�u tand my dghcs ed ubave. <br /> 8igr►otu re <br />