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Jun-30-2003 09:42am From-CITY OF ORONO +9522494616 T-732 P.003/003 F-672 <br /> ' - . <br /> $ec.13.0�Rl!'xHTS OF SL($.rE�TS OF Dr1.'�A <br /> Subd• 1. Type of dnca. 'lhe rights of individuai oa whom rhe dssa is szorcd or to be sroted shali he as 9ei fotsh in this section. <br /> Subd.Z. Inform$tlon re4sared to be given indl�idv�I. �t iudividnal aslced w supply Fnvat�or confidepQa4 daca coaceraing himsetP sha11 <br /> be inEor�ed of: ia)�hC purpase and inrsnded use oP shc roquesud��+wi���e�°o�conse uencc�s'ta�Pmm h,is s��►pplYinS or cfusie6�+uSPPiY <br /> (b)whasher he may refisse oY is lcgaify�quircd co supply ihe requcs�Cd d�ta;(c)any � <br /> private or cv�dendai dsus;and i d)ehe idendry of o�hcr parsons or enudes au[horize d b y srate or fcdat3l!aw ro receive[he data. This requircmna[shall <br /> nqc appty when an individust is askcd ca supp{y invesnSadve dara,pursuan[w secdon 13.8?, subdivision 5,[o a Iaw enfo�e�eas o�cer. <br /> Thc camrnissioner aY r�venue muv Iacc ihc nORCe reoui[ed under this subdi�'sion in rhe i dividual incomc ffix or ro sax tefu d <br /> iesituction insrea of o chnsa forms. <br /> Subd. 3. Aceess ta��ie�by individual. Upon reques�to a resQonsib[c aucharicy.an iridividtsal shall bc info�d whe�hcr he is thz subjccc <br /> oP sroced da�on individuals,an.d wfienc�r ic is ctassif�ed as pu�iic,private or cott�[deensJ. Upon�s futther request,aa individual who is�hc Subjec� <br /> of scored privau or publie da�s an individuals skall bo shnwn thc dats wirt�ouc any ch3rgC to him and,if he desires, sha➢be informed of the contenc <br /> �����oP[hat d3[s. Afu�'an in�tividelal hss been shown rhe priva�e dan and infosmed of its mcanin8,rhe daca need noc be disclesed to him for <br /> six monchs�here�rssr upless a dispute or action pursuans w this secdon is pending or addiuoaal d$ra on the inQividual kas becn cellecud at crcated. <br /> Thc responsib3c auihori�y shall��rovide copies of che privare or public dara upon re4ucst by�tte individual subjec�of the daGa- The responsiblc au�horiry <br /> rnay requirc the nquesdng petson�o pay the accual cosrs of making.cerdfyieg, and cou3pilittg ttie copies. <br /> Thc responsibie autharity shsll comp3y imntedia�cly,if poSsibie,wich auy requea�made pursuan<<o thia subdivision,or wiihin five days af <br /> �he dare of che reqnes�,cxeiuding SantrdaYs�Sundays and le$a]holidays,if immcdiau comF[�anee is noc Possible. If he c�oc eott�piy wich[hc requcst <br /> wirhin th3t iune.hc s5all so infurm che individual,and may have an addiaa�l fivc days wirhin which to eomply wi�h[he requcst,oxcluding Sutu�d�ys, <br /> Sundays and lega!holidays. <br /> Subd.4. Praeedurt whea data is nat accuraie or eomplete. P�n�►�idual may con�st dte accuracy or completeness oP public or private <br /> daca cenccmin8 hirnself- To cxercist this right,an individual shaif aoafy in wriung nc�resP4nslhl�a�Th°nry'describing�ha n8nire af the disagYeemaac. <br /> 'I'he rCSpor�sibl�auchoriry shall withits�d days e't[hcr_ (a)cornc�thc dact fauad ro be inaceurasc or incompicte and atutnp�[o noufy past Lecipionts of <br /> inaC�urace or incomple�e data, incEuding r�cipieers named by �he individual;or(b)nodfy the individual tha�he bCtievcs�h�dssa to ba coaec�. �ara <br /> iu disquce shall be disciosed o«ly iP d1e individuai's s�tcmen�of tlisagrcemen[is incltsded wi�h the disClosed data. <br /> Tku deserminarian nf ihe tasponsible auchoriry may bc appealed pursuanc co the provisions of che admimstrarive proced❑re aac rel�dn� to <br /> conccsud c�sas. <br /> DAT� PRIVACY ADV1SaR'Y <br /> In aeeordance with M.S_ 13.Q4, S�bd.2, "Ria,�ts of subjtccs of data", we would like to inform you that your requesc <br /> for a permi� or Iicense lrom ihe Ciry of Orono or any af i�s departznznu may require you to fumish eertain pr's'vaEe �r <br /> COn�den�ial inforcna�ion. <br /> You are notified tliat: <br /> i, The infonnation you furnish wili be used to deternvne your qualificatian f4r the germit or license requestad. <br /> 2. You may refuse to supply daza, bn� refusal may require thac rhe Ciry deuy the permi� or license. <br /> 9, The infor�aiacion may be shared with o�her locaI, s�ate or federai ageueies to ihe ax�ent neeessary zo process <br /> the permit or lic��se. <br /> 4, If your requcsted Qermit or lieense iequires CouAcil �ccion to approve, some utformation may become <br /> public. <br /> $, You have; cenain Tishts under M.S- I3.04 (avail�ble upon request} �o review private d�ta on yourself. <br /> 6. Your full name is required to process Lhis apQlication or permic. <br /> �C� 1���4r�,? % ,� . <br /> F�=st <br /> ��aa�� �^ l �� <br /> 2���S J�'G���� ,v� f��� <br /> Addresss a��D J� /v � 7�'�"L --��.3 � <br /> 5tate 2ip 1?aone <br /> Ciry <br /> I understand my rigbu as 5=azed above. � . <br /> �i1�'" � ` <br /> Signaaxre <br />