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� -CITY OF ORONO � 6122494616 01/25/00 15:52 � :03/03 <br /> � <br /> See.l3.at 1�IGH7S OK SlTBJECT$OF p,�T�► <br /> Subd, L Type of d�ts. TbG t7$Flfi Of Il1E1V1dYi� 00 wbAm fb0 d001 IS Sl0[Cd Of[0 bC 3tORtI SO7��b0 S9 9CC fONl lfl thl6 6tCp0U. <br /> SuDd.�. [nformation reqidred to b��lrea IndlHdual. ,in iadividual uked�o eupply priv��a or conffdendal d�ti coceeruing 6lm�alf shall <br /> ba lnlormRd o�: (e)ttla purpose and,fAmnded use of the rsqueerod daw Withia the toUecdag Ytata agcacy, polidcal�ubdivieinn, or sauewids ryemm: <br /> ib)wEa�herhe�ay refuse oY is le��lly rsquind io supply�e requcsced dau;(c)eny knawn coauqucuce ansin�from his nipplyin�or retiisin��o supply <br /> privnre or tonfidenosl daW;nnJ(d)ihe idendry of o�her persotis or errocia9 authorized by sw�or fcderal(aw ro receive the da�a. This rcquiremene shall <br /> noc apply when�n indlvidual is asl-ed �supp�y imadQrrive daa.pursuan�to secrivn 13.82, suAdivi9ion 3, eo� Iaw enforcemenc officer. <br /> ')1�e eommis�}�4,�+er af reve uq e mpY vl�.:che nodcs remiired ttn+ler ihis sutx#iviai�� in �,e ind;ridur! incomc nY or oroaertv n: cefund <br /> 10�a ycyons inscaad u(on thpao f�rmo. <br /> 5ubd.3. Aec�e�t to duta by individual. Upon requasc co a responsible auchoriry,an indi�ldual sh�ll be informed whether he u the subjece <br /> af smrtd dsd on lndividual9,and w�e�her!e is elusified as public,privaee ar eon�denp�l. lipon his furthu requecc, rn individual who 1�Ne subJert <br /> of scoml p�iviee or public dra on indiriduva ahall De shvWn�he dan wichouc rny charge eo him�nd,'if he deaires,�hall be lnformeA of the con�ent <br /> end meufin�of�hat dncr. Ahsr an inJividu�l hu been shown che pri�am deu and(nfotmed of ics meaz�ing.�he dara need nut be dlsclosed to him for <br /> six o�ontha therc�fter unlou a dispu�e or ution punuanc►o rhis seccon is pendin�or iddirionaJ dira on du individual has been collected or crea�ed. <br /> The napon�ible iuihoriry shaJl provide copie�of Ne priva�e or public dara upon tequerc by die individusl�ubject af rhe dara. Ihe responsible�uch�tiry <br /> may mquire the requesdng parson tu p�y the ocmal cos�s of malci�f�,certifying.�nd comp�lnq t6e copiea. <br /> The r�spunsible auchoriry shall comply immediacely, if pessible, �virh any rcquest madc pursuanc to this subdivlsion,or wichin five daye of <br /> tha due of rha raduae,excludin�San�rclaya.3undays anJ le�nl holiday9,if immediite complianco Is not pussiblt. If he CnMo�camply with 1he tequest <br /> Withln thot tima,he shall�o infocm che in�ividual,�nd mey ha�e an addidooal five days Within which m comply wi�h ehe reques�,exctuding Satunlays, <br /> Surtdays�nd le�el Aolldiy�. <br /> SuDd.4. p�ac�dure wnen dau 1t not�ccueate or cumplate. An indi�idu�l nuy contest che ec�uroey or comple�rnesa of publlc or pri�•a�e <br /> dsa concaming himsel�. To eierc�te this�gh�,on indivldual shall nuti(y in w�innQ�e respoasible�urhoriry desetiDino the nxture oP the dis��reement. <br /> Ths respor+eibl�au�huriq�Yhall WjNin 3U days eitf:er: (�)corroct the data found co be i�uccura[e or iacomplete snd oaampt to noqfy payt«cipien�s of <br /> inaccunre or incom{�lete deta,includin� ro.oipieets named by eha individu�l;or(b)no�ify e1�e individuol th�r be believes�he dars[o ba cortec�. Daca <br /> in df�puie ehall be ducloaed oNy if tha indlvldual'�sratemenc of disagreernanc is included v�iih the dis�loscd dnu�. <br /> Tlu determinapun uf tAe tesponslble autlloriry may hc appenled purauane�o the provislons o(ehe �dminiatrative proceduro acc nladng ro <br /> coneested eusea. <br /> p��� P$�yA�Y aDYISORY <br /> In accordance wi�h M.S. 13.04, Subd. 2, "Righcs of subjects of data", we would like co inform you that your request <br /> Yur e permi[ or license from the Ciry of Orono or any of its depattments may rrquire you to furnish certain privace or <br /> ¢opfidential information. <br /> You arc notifled that: <br /> 1. The information you h�rnish will be uscd to decermine your qu�lification f�r the permit or license requesced. <br /> 2. You may rePuse to supply dnta, b11L tC}ti19$I may require thnt the Ciry deny the permit or license. <br /> 3. 'l�e information may be shuad wich oeher locai, st3ce or federal agencies co che extenc necessary to process <br /> the pet'mit or license. <br /> 4. 11' your requested permit or ticensc requires Council action eo approve, some informatina may become <br /> Qublic, <br /> 5. You heve c�nain rightt undcr M.S. 13.p4 (avnilcble upon requesQ to rev9�w pri�iate data on yourself. <br /> 6. .�Your full name is reguired rocess [his npplicacion or permic_ <br /> ��-�.Q,1�� � � �._ <br /> Firec Mlddla C as� <br /> 7J�J �1 ��1(�C1, .�l�"', �V�-.� tir�,�,. a \��,t <br /> , <br /> � as. <br /> �v��,�,.�;�s �� � �.o� g�'�- ��� <br /> Clry —�– Srue 21p Phone <br /> i undtrstand my ri as above. <br /> :�� • L.�� <br /> 5i�nuNro — T.~ <br />