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TY OF ORONO � 6124730510 09/24/96 14:00 �1 :03/03 �N0:5?2 <br /> Ssc.13.04 ltl(�l'1TS OF SUBJEC fS OF D�'i'�1 <br /> Subd. 1. Type of dab. 'TNe tiyhts ot indlvidud oi��hom the data is aeored or co be scorrd shall ba as set fonh fn this seedon. <br /> Subd.3. Inlonertlon riqu�rrd to ba�Iv�n iod(�Idu�. M[ndividurt as�ad to supply priveu or oonfidendal d�ta concartdng himaelf Rhall <br /> be(nfortned of: (�)d�e purpose and imm�ded use oP the nquested date within the collecdn�6taue agenoy,polidtal aubdivision,or snteu+ide ryctem: <br /> (b)w}�ether be msy rofl�se or i9 legally required co supply►he requesud dvu;(c)�ny knoum consequence ariaing from his supplyln�or reflising to supply <br /> privsce or coaflden[ia!daa�;and(d)U�e idenrih of od�e�person�or enddes aurhorized by sum or feder�l law�o reecive�he da�a. Thts requireme�c shull <br /> not�pply when on lndividuel ia asked�o eupply in�esrig�dve daa, pursunnt[o�ecdon 13.82, subdivision S.[o a law enforcemenc otPFcer. <br /> a cum�,�sgner�(,rov_enue muv alace �he nocjce r�auired under is subdi�isic� in e ind(vidue�l income rax or orooer�v ux nll;nd <br /> _ 11lE4�dont��sr�ad o!on�►o�o torms. " <br /> SuDd, 3. Arcees to data by individual. Upon rcquesi to a rcspunsible authonry,�n iaAi�fdual shall be lnformed whother he le�he subJeet <br /> ot�tared dan on indlviduals.�nd wh��ar ic is elissified as public, ppvate or conPldenual. Upon 6is tl�rther rcquest,an individuat who b�he subjtct <br /> of�wred pri���e or Nublic da�a nn lndividuals slull be shown rhe da�wf�houc sny chzr`e u�him and;iF he deslres,ahdl be infortned of rhe wnten� <br /> rnd meaning of diat da�. Af[er on indi�idusl his bein shown�he priv��n dara and ia[ocmed of iu meaning,the dmn need noc be diaclosed to hlm for <br /> d:ewnrha thsreafior unlerr a dispu�e or�criun pursuan[oo ihis seeeian is pendfnQ or addidonal dara on ihe individual haa been oollec[ed or creareJ. <br /> The r�apuoaible�uthpriry chrlt provide copiea of rhe privi�e or public dara upon requesc by�he indlviduat cubjeci of d�e da�a, Tt►e reypnnsible au�ha�iry <br /> rt+ay requiro�he raquettin�pmrson ro pay�he actual coscs�f mak(ng.certif�ino.and compfling rbe eopi�s. <br /> The responeible au�h�riry ch�ll comply immadiuely, if possible,wich aay requesi made pursuunt�4�his subdivision,or wiil►ln fi�e days of <br /> �he dtre of the reyuest,excludinQ Stmtdays.Sundays ond Ieg�t holldays,iF immedla�e compliance is not possihto. INhe cannot comply with the roques� <br /> wlrhin�ha�[fine,ho aha1)w inForm�ha lndividual,and m�y ha�e�n oddldonal five doys wi�hin which w comply wi�h th�requesc,excludlt�g Saaudays. <br /> Sund�ye and le�wl holldaye. <br /> Subd.4, Proeedure wh�n dnia:s not accurAte or camplcte. An inJf�idual m�y eonms�the accu�acy or complerenosa of public or priv�ce <br /> d�u eoncornln�himself. To exercise rhis right.on indi'viduel shall nout�in writinB the roapcinsible�u�hud�y describin��e neNro of�ho d►cagroemcnc. <br /> The teepen�lble authoriry sltell withi»30 days either: (v)correcc the dam found eo be inaccurxte or incumpleu And ot�empt ta nodfy pau reoiptents eE <br /> inaeeunte or inc:umplete dpra, Includin�recipienta named by [he individual;or(b)nodty We individual chat ho belleves rhe darn co be oorrece. Data <br /> ip d�tpwe ihsN be disclosod only if t]►a indlvidusl's su�emen�of disao�eemenc is includad wirh the di9closed dva. ' <br /> 9'he detemtinn�ion of�he rrsponsible au�liariry may bo appealed pursuani eu th�pro�isionc of Ute adminixusdve proceduro act relarine w <br /> aoncesrod e�ses. . <br /> ' DATA��A�Y A�Vi$OR`l <br /> In socordance with M.S. 13.04,Sabd.2, "Righcs of sutijec[s of da[a", we would like co inform you thac your requesc <br /> for a permi[ oc license from the City of Orono or any of its depaitments may require you to furnish cer[ain private or <br /> confidential information. <br /> Y'ou are nndfied thar. <br /> 1. The informetion you furnish wltl be used t�decermine your qualification for the permit orlicense requosted. <br /> ' 2. You may refuso to suppiy d:ua. but te[usal may require that the City deny the permit or licc�lse. <br /> 3. T'he information may be shared with othCr local, state or ftderal agencies to the excent ncctssary t�process <br /> tha permit or license, <br /> � 4. . Tf yout requeeced permit or license requires Council action to approve, some infarmatton traay becomc <br /> ' public. <br /> S. You have certa�n righ�s under M.S. 13.04 (av�itable upon cequest) to review private data on yourself. <br /> 6. Yaur fitll name is required to process thls applica�ion or petmit. <br /> . C�, <br /> , � Firct O � M dl ,}� ` Lu�. <br /> Fl 1 <br /> � �, �n � � ao 9�a- � . (�o� � <br /> ���y, Soa Zip Phon� <br /> ' I•understand y dghts � s�ace above. <br /> • , ���� <br /> 8ianaa <br />