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�°d OF OR�NO � b�247305�0 09/�4I96 1�:00 � °03/03 ��e5�� � <br /> s:�.��.aa�r�y�'�s�F se,ra�c�s oF�A�.� <br /> �ubd. 1. '�y�se oP dsta. 2Ae el�hts oF iadlvidual o�t whom the da�Is scored or to be acomd 96aY1 be ss set forth in this�af$a�a. <br /> Subd.3. YnPo�atlo�roqtairad to ba�Iren iadi�idc�i. An(udividu�l asked to suppiy privare or aonfideaual daa�cancarcdng hitnaelf Fhalt <br /> be Inlovmed oPt (t)dle purpose and intanded use o�the aequescaJ d�ta withiu ehc eollecdnQ 9tate agenoy,potldcal subdivisian,or smtewide rysmm: <br /> (m)whether hs may raPuse oT is legally required cn supply the r�equessed dsu;(c)any�soam consequeaae ariaing from his supplytng or refUstng to supply <br /> privato or ooaflden[fal dsm;and(d)the idenrity of odiet persons or endries aud�orized by s�a�e or federal law en eeeeive the dara. Tht�requtreme�c shull <br /> �voe epply when an individuel i�asked ao suppty imetrig4dva daa,pursuant��secdon 13.82,subdivision S.to�law enforcement olPEcer. <br /> ,.� <br /> �g,���,signer QP ie_�enue ma� alace che noqce re i�ed under is subdivisiRn in �he indlviduel income raX or nroo�tv r�T iSind <br /> . _. 1RE4F�lant i��t�acl�f on�iu�a tgr�+g. • „ <br /> 5udd.3. A�ceas eo data by 6�sdt�idual. Upon e�ques�ro a respnnsible auchoriry.an ladi�idual shall be informed whesher he la the s�ibjees <br /> of otoeed drra on as�dividuats.amd whedtar ic is elassified aa public,p�ivue or conPfdenual. Upon h;s ft�rther roquest,an individual who is�he subjtce <br /> of swred pri�ace or pubiic dara ea individuals sh�ll be shown�he data withouc any charQa w hia�end;if he dealrea,ahafl be infoemed of the conten� <br /> ond rv�6aning of df�t datu. Aher�n indi�idus!has been shoWn�he pri�e�e d4ra and informed of irs meaning,the dau naed ewrba di�elased w him for <br /> s�a snnnrhs thereafur utilea�a dispu[e ar acaon pursuan[ao ahis seceian e�pendins or addirional dara on ihe individual haY been onllecced or creared. <br /> 11ta tsspntuible authpriry 6h�11 pro�ide copies of rhe pririre o[public de�upon Yequese by the individua!subjet�of the dsta. ?he responsible auchoriry <br /> er�ay requiro rho raqueatin�pmeson ro pay d�e a�tual cosrs�f maktng,esttit�ino,u�d eompiltag ehe oopi�e. <br /> The�espunaible suthoriry shafi compiy immediaesty,if possible,wi�h anr eequese m4do pursuant u►Wis subdivision,or withln fi�e days of <br /> d�e dare of ehe eequea[,xxeluding 9acuedays.Sundays end 1eg�l holldoys,iF immedlata tompUance is not possiblo. I('he cartnai comply wlth rha eequesc <br /> within thac clme,he�hat1 aa inPocm eha ie�dividual,and may ha�e an adrlieional Fve days wid�in which m aomply wish the eequest,exeludlflg S4q�rdays. <br /> �andiye ind le�al hol(daya. � . <br /> Subd.4, &�totedure ahen alnia is not accurata or eoenpl¢te. An indlvidual m�y conffis�tha accw�s.cy nr complereno�of publle or privu�e <br /> dva coneorn�himselP. To exerci4e rhis right,an indi'viduet shs!!noa�r in wriring�ho respunsible surhodry desctibl�g d�e namea oP the dltagreemeni. . <br /> The�eapenalble autho�ry�I�ell withi�30 days ei�her. (a)cotrecc c�e dam found ea be iniccueate or incc�mpleu and saempt te nodfy pgit reeiplenes oE <br /> inaeeucnto or fn,cumplete dpra,Includin�recipienu named by d�e indivfdurl:or(b)noqijr the indivi�uat thec he belleves the dan►co bo cornaeL Dara <br /> ia d�epu�e ehall be disclesad o�ly if the uullvidusl's seuemtnc of dlsaqrcemenc is included with the di�cloaed dara. ' <br /> �'he dotettnination oP ehe ersponsible au�liori[y maq bo sppealed pursuant to 990 provisionc o[ehe adm►nisuadve procedure act rela4ng w <br /> con�ested eeees. <br /> ' gIATA �Y'dt�C�t ADVI�ORY � � <br /> 1n sccordance with Mi.S. 13.04,Subd.2, "Itighcs of sulsjec[s of daza°, we would like to inform you that your request <br /> for a permit or licens� fe�m the Cicy of Orono or any of its departments may requiro-you to fuenish certain private or <br /> confidential i�formation, <br /> 'St'ou are no[Ified th�[: " <br /> 1. The infoem�tian you furnist►wtil be used to determine your qualificacion for the permic or lictnse requosted. <br /> 2. Yuu may �efuse to supply d:ua. buc refusal may require tha[ the City deny the permlt or license. <br /> 3. The infarsnatian msy be shartd with othCr loeal. scace or fedetal �gencies to[he excenc ncce�sary �o procoss <br /> the permit or license, <br /> • 4. , Yf your requeeted pecmie or license requires Council aetion �o approve, some infarmatl�n may become <br /> ' publtc. <br /> 5. You have cercaln righ�s under M.S. 13.04 (available vpan request) to review private data oa yourself. , <br /> 6, Ynur fult name as requirod to process„thls appliea�ion or permic. <br /> . �0., 'f� � <br /> � �fiao �. �o�� �- � d�al� �sL <br /> �`�` �; m � �a c��� � (�.� <br /> _��_._�, ��� ' r� �� <br /> eiry . - �n� ��� Pt�Re <br /> ; <br /> ' t•uaders d tny right� � sta�ed above. <br /> Signa�u� <br />