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Nov-24-2003 10:25am From-CITY OF ORONO +9522494616 T-455 P.007/009 F-�82 <br /> � $aC.i3.0A R1CrATS 4�'S[TBJECTB Q$r}pTA <br /> $ubd. 1. 'Y'yge aC data. Ihn righ�s oP individusl on whom dte data is SWred or to be swred shafI bc es stc for�h in this s�cbop. <br /> Subd.2. Iaformatioa reqidrtd to be�vea ind.ividval. An individual asked to suppiy privsrc ar conf�dcnda!dsra conceming himsnlf <br /> shsl!be utformed of: (a)rhe purpose and in[ead,�usc of d�y req�kd da�wi�hin the collecnng s�ate agency,potidca!subdivisioa,oe stauwide <br /> systrm:(b)wtiethcr he may refuse or is lcg9lly required m supply the reques�cd data; ic)any Imown consequcnce arisi�Ciom his suPAIY�S or <br /> teCLsit►g ro Supgfy private ar coafidearial da�;and(d)�he idcnriry oPathcr persot�or encc�s authoriud by sa�e ar fcdcra]E�w cq receive the da,ta. <br /> This requiremens shail noc apply whcn an individusl is�sked to snppty iavestig3dve dar�, pursuant to se.don I3.82,subdivision S, �n a law <br /> enforeeracnG officer. <br />� �S.4�Smisiiorter of reveriue ma�nlace the norice rerniirtds���this�thrlivieien in the indivi�val intome r�c 1 erapem�1x rrfimri <br /> � 5 C�O R�8 5, <br /> Subd. 3. Acce4s to dn�by indlvidual. LTpon requcs�to a respaasibk au�horiry,an individuut shsll 6e iafo�mcd whechcr he is d�t <br /> subjrCt of stored dara on iMividnals,and whedter it is classified as public,priva�ar ca�dearial. Upou 4is further re�uest,an ind;vidual who <br /> is the subj�ct of scored pnva[e or publie data on individuals shaIl b�shown rhe daza without any charge m him and, if he desiirs,shall be informed <br /> of�hc coatcat and mcaning af[ha�dara. Aftcr an ir�dividaal has bern shown ihe privato dat3 and inPornled af its me�1Q$,thc dars need nat bc <br /> diseIosed m him for sbc months�ereafrer uNcss a dispu�e or actlon pv�uarn co d�is seeapn is yrnding or addinonal data on die individual has been <br /> eolleeced or ere�rrd. 7hc respongibie aud�ociry shall provide copies af�hc priv�or publie dgra upon rcques�by�he indivi�usl avbject of rha dan. <br /> The responsible authoriry may rcquire d�e requesrin�persaa W pay the aetuat cost9 of making,cectiPying,and compilic�dzc copie�. <br /> The responsi6le auehpdty sha11 comply immediarelY,if possblo,with any rcquesz made pursuanc co chis subdivisien,or wirhin fivo days <br /> of tha dau of thc rcguast,exclading Saturdays,Sunflays and lega!holidays,iP immcdia[c compliance is no�possible. ;f he cannot comply wirh <br /> rhe reques�wiehin that timc, ha shaIl so inforsn the indiviqual,atfd muy have an addirional fiva days wirhin which m corszpiy wi$�� reqaest, <br /> excluding Sa�urdays,Suedays�ad le�I holidays. <br /> 5ubd.4. Procedure wheu data 1�nat accwate or cumplete. An individua!may coeias�rhe accuracy or complarencss of public ar � <br /> privace da�co�ucraing himgriP. To eaersise chis righc,an ir�dividual shall aodfy in writing chC cesponsible aurhariry descnbing che aacurc of rhe <br /> disagrcemeru. ?he ras�onsi64e auttwriry shaII within 3Q days cid�er: (a)correcc the da�found cn hz;naccu�atc ar incomplec:and aaempt ra notify <br /> past recipien�c of inacevraee or ineomplcte dara,inctuding rec;p�ancs named by�ho individual;or(b)nonfy rhe individual�.ic he bcjieves che dan <br /> to bc cortcct. DaCt in dispute shall ba disclosed only if thc individual's s�atemecu oP diaagrcamcnt is inctuded wlrh the discloscd data. <br /> 1'hc dct�rminaCon oP rhe respansible aurhoriry may be appealcd pursuaae�o the provisian#vF the adminis�a$ve procedure aet rclaung <br /> w concesccd casrs. <br /> D RN b'VISORY <br /> I�l aCCordanCe wiih M.S. I3_04, Subd. 2, "Rights of Subjects of data", we wq►�ld like to inforui you thae yQ�r <br /> request far a permi�or license from the�ity of Oronp or any of i[s de�artments xnay require you to furaish certain <br /> private or confideatial i.uformation. <br /> You are notified thar. . <br /> 1. The informaGon you futnish will be used to determine youx quali�casion for tlze permit or lice�se <br /> reques�ad_ <br /> 2. You may refuse to supply data�but refusal may rtquire that the Ciry deny the perm.it or license. <br /> 3. The infarmatio�l may be shated with at�ler loCal, state or federai ageucies to the ezjent necessary to <br /> praess ths permis or license. <br /> �. If your requested permit or lieez►se requires CounciI action to approve, some informatiqn may become <br /> public. <br /> 5. Xou have certain rights uii�ler M.S, 13.Qq�(availab�e upou request) to review priv�te data on youzself. <br /> 6. Your full name is �equired ta proCess this application or permit. <br /> �o�na.l� �--� . Qr�i e,� c� <br /> F��Sz LI D�� 1-�� l M`e',` �o . �S� <br /> � n <br /> Aadr����n c�_ M� � l �'���a o ���3 3 <br /> ���' Scatc 2ip Phone <br /> i uuderstand my rights as ated above. � C <br /> O�- ���d �a��n � '�5 , <br /> � <br /> siSsranuc � <br /> � <br />