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TY OF ORONO � 6124730510 09/24/96 14:00 � :03/03 N0�522 <br /> 3sc.13.04 R1GIiTS UF SUH,t�CTg OF DAT� <br /> Subd. 1. Type of dW. 76e rijdu of indfvidud ois whom ths datx i�sco�ed or to ba zw�zd�haU ba as mt fonh in thi�uedan. <br /> Subd.1. Inform�dn reqtdr�d to b��Ind(•Wua�. M Individual asked to�uppiy Privta or aonfideoritl daa canasrc�ing himsalf,diall <br /> be InlortAed oft (t)the purpoce tnd Ititonded uu ot dls tequested d�4 widda the colleedn�lnte tgenoy, polldCal subdlvislan,or�nte+vide sy�mm: <br /> (b)wluther M may mfli�e oi i�Ieeatly required m supply the raquesred dau:{cy ury known consoquence ititit�from hls tupplylt►�or rell�tlny ro supply <br /> ptivue or conAdend�I d�a;and(d)rhe idendty of odte�person�or eaddes authodxed by sum or fedenl I�w m rrxcive d�e dua. Thd trqulreme���wt� <br /> noe�pply when an indiridu�l i:esked co mpply Invenisadve daa.pursuan�to aedon 13.82, subdlvirion S.to i I�w enforcemenc otfkar. <br /> 7ha cammiufoner Qf revenue m�� ol�ee �he eocfce reauind under�his subdivisfon in �e indivld�,ineotne ax or arooenv nz��� <br /> ___„ �dOpt�II,�Lnxc!u(Oq th01a�on0i. „ <br /> SuDd. 3. A�to daq by indtridual. Upon rcqueu to�rcapansible mtdo�ity,�n ladl�fduil shall be informed whather h�L t6e subJeet <br /> o[�tond drra on iadlvidual:,and wludiar u is clissifiod u public.P�ivue or conMetstal. Upon hi�fl�rdier rcquese,�n t�dividwl who i�die subjtcc <br /> of aomd private or publlc dua nn lndividuds sFull be zhoWn�he dan without aeiy ehar�e co him u�d:tf he dedres,ah�ll be infotme�d of d�e conten� <br /> �1+d n+lanine of d»e daa. Aher�n individuat hu bean shoWn ihe priv�u���omkd of iu meaning.tAe dara oeed aorb�alscbsed w him for <br /> dx eeonrhs tkenafyer unle� a dispute or retfon punuuu oo �his secBan is peedia`or addidoral dara on tbe individud h�u been odkcted or creatnct. <br /> 1Us raponsible authQriq eiull p�ovido copiea of rhe privam or pubik dea upon riequesc by�he individna!w6Jsct o(d�e dan. 'I1rc rupons�ble tutho�iry <br /> a+aY reqaiee the mquastini Parson ro pry dro aaaRl cosa of m.kia;.certiiyinr.�od eomplllaa�e eopi�i, <br /> The uespontible wthoriry thall comply itnmedl�taly, if possibk,vith a�request medo purcuant oo acis�bd�vit�on,or.vidiln flye day�of <br /> du date of q�e roquet�,excludlnR 9taitdsys.Sundays�nd k`d hollday�,if bmnedlate compliance u noc pouiblo. Ihhe anna coa�piy wi�h the roques� <br /> �lthln du[dme.he ai�all w inform�ta ladividual,and may ha�e an.dditiodd flve d�y:wld�ln whtch co wrnply wirh the cequeat,�xekidk�Sawrday:, . <br /> �y��nd lepl lwlid�y�. <br /> Subd.4. PlOCld W/N�l�17 ADIY ift AOl OCCtlrit�Or COmpIKl. An tndlvWwl m�y co�n d�e ucuraay or complerono�s of publlc or privaro <br /> dia coacornlni bimself. To exercise iAis Naht.�n indi�idwl shall aoeil�in t+tidnQ the responsibie suetwri�y deu�iblo�d�e ntatro of tho d(a;reethcnc. . <br /> The te�pearJble�uthoriry d�dl wi�hin 30 days euher. (�)eomecc the datr found w be inucunte or incnmpl�ce snd�ciempt oa nodfy pue neipknu oE <br /> inKau�te o�fr�camplete don, Includin��cipfenu nsmed by�e Individuaf;or(b)nodf�r dx indiv�dwl tMt he belleves tha dara m be ootrace. Daa� <br /> le�d{spu�e ah�lt be ditcto�ed anty if fia indlvidusl's tumnoeat of diu�[rxr�xn�is itklt�ded with�he diulosed dia. - <br /> 'i1u detemtinauon or�he nsponsible au�horiry may bo appealed purs�aui m�ht pruvisb„c o[rha admtnisuvdve procedure act rrl�cin` to <br /> conoe„ed oa�es. <br /> ' pATA iVACV A y��� <br /> ln accordance with M.S. 13.04,Subd.2, "Ftlghcs of subJects of data", we would like to infocm you thet yotu request <br /> for a pecmic or lieertso from che City of Orono or any o�its depatttnent� uuiy requfre you eo furnish cectain privue or <br /> confidential lnformation. <br /> You are natified that; <br /> 1. The information you furnish will be used to decermine your qualificuion for ehe permic or iicense requested. <br /> 2. You auy rafuse �o supply daea� bue retuscd aiay require thac �he City deny the permit or licenae. <br /> 3. The infotmatiom m�y be shared with o[hcr loeal, scace or fecl�tal agenciea to the extent nce�ssery to pmcess <br /> thc permic or liansa <br /> • 4. . If your cequaeted pecmit or liceau requirec Couucil aetion to appmve, come infarn�atlon may become <br /> ' pubtic. <br /> S. You have certain righ�s under M.S. 13.04 (av�ilable upon request) ro roview private data on youraelf. <br /> 6, Yaur full name is required to process,thls applicuion or permit. <br /> � ��c G �4� ��0�� <br /> � � � �a� �. .� - d�a ,�� �L <br /> �` � � a� � .�oy�. <br /> ► � � <br /> c�a - am� z� rho� <br /> ; <br /> ' I•underatand dghts as :� nbove. <br /> 8ign�tu <br />