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Ju1-17-2008 10:58am From-CITY OF ORONO +9522494616 T-726 P.003/003 F-698 <br /> Sec.13.04 Rf GtiTS OF SUBJ�CTS OF DATA <br /> Subd t. 1y+pe of dara. The righu of individuaf on whom ihe dara u sYorrd or w be stored shsli be as set Corih;n thi�aeccion, <br /> Subd.2.Information required co bc given individu�l.wn individusl asiced w supply privaze or confidrncial da�a conceming himselfshsll be <br /> informad ofl. (a}the purposc and intrndrd use of d�e requested data widiin the collecung�Yare agency,polidcal subdi�•�sian,or s�aecwidc syscem;(b) <br /> whcthcn c�may refuse or is Iegaf ly requirod w suppiy[he roques�ed da�;(c}rury known conscquCnCv at'ising from his�upplying or rafusing to supply <br /> privutc or confidendaJ dam;artd(d)ihc ident;ry af o6}1er petsons or ontitics�uthorized by State or fedotal Isw to raceivr the dt�.This iequitament shall <br /> noc npply when sut individual is askod ro supply invbsiigative dxtFs,pursuant rn secijon 13.82,subdivision 5,to a 1aw cr�orcoment officnt. <br /> Tha cnmm;csi�ner of revenu�mav n)q¢{�j��pci�r rcnuiied under t}tic sultdivisjen„1P.Lhr�andividusl incnme rax hr n,T�mny LY*efund <br /> inawc�ians instead nfon thosr fbrms. <br /> Subd.3.Access to dap�by irxlividual.Upon roquas�so a responsibla auenoriry,att individusl shsll bc infomird whether he is the subjcct of <br /> �rornd dam on indtviduals,atld whethaf ic iS Classifidd 1S pub[iq privuse or confidonuaL UpOA his iLP[her reque9�,Pu1 uldividua)who is thc subjcei of <br /> stored priva[e or public dltta on individuoks sh�l be shown thc data without any chacgc co him and,if hc desires,shall L�e iaformed of t}w concent and <br /> meaning of ihas dat�. Aftcs an individu�l has bean showt�the privata dau�and informcd of its mearung,the d�uu n�ed noc bo d;sclosed to him for six <br /> manths chcreaf[er unless a dispuc�or action pursunnt to chis eecdan is pcnding or additional d�uuon rhe individual has t�een collecred ar creaied, The <br /> responsblc uuthority shatt provide copios of cho privato or publie daas upon roquost by the individusl subjccs vf the data, Tho respons�blo authoriry <br /> muy require�he�cquesting porson jo pay�he aewat cosss of mnkin�,cerqfyin�,And compiling she capins, <br /> The re��ponsible aurhority shnll comply immedieufy,if possibte,with any requess made pursuan�co[his subdiviaion,or wifiin fiva days of <br /> tha date of thc requesc,excludin�Saturdays,Sundays and legal holiday�,itimmediere complianc�is notpossible.!f qe c$ncwt camply with ihe roquce� <br /> within that rime,he shall so i�tform the tndividual,artd may h3vc an�dditionsl five days wi�hin which to comply with the reques�,excluding Saturdays> <br /> Sundays cnd lcga!holidays, <br /> � ' Subd.4. P�oCedure when dnta ie noi accqrttu or cpmplote.An iAdividu2l msry conrs.st tho�eu�aCy or eomplrrrness nf�ublic or privatt dstu <br /> coAcernins 6imyrlf. To exrrci�c thi9 risltc,an individual shsll notify in writing rtu respprtstble auchority dnscribing thr n�ure of�he diksgrcanrnt,Ttte <br /> re�ponsible aq�horiry shali wizhin 30 days�i[her: (a)c�rrecc thc da�found to bo inaCoutatc ur incomplcu and at[en,pt to notify past recipiants of <br /> inancurau or incomplace da�a,including ru:ipiencs nnmrd by d�c individual;or(b}notify thr individua!chai he bel ieves the daca to bc conacc. Dak�in <br /> dispuro shall be diseloscd only if thr individual's�e[cment of disagreement is;ncluded with iho disclosed daia. <br /> 'T'he determinntion of�he rcsponsiblc auchoPlry may be 8ppe81ed purb-uant W the pPOYisi0zlS of ihc ndminisCxtrivC proCedure nCt rcluting to . <br /> con�ested c�ces. <br /> D.4.TA PT2T'VACY ADVISORY <br /> Tn accordsncc with M.S. 13.44,Subd.2,"'Righrs of subjccts of ctata",we would lil:e to in#'orm you that your rcqucst <br /> for a permit or liccnse from the Ciry oFOrono or any of il:s dcpartments may require you to furnish certain private or <br /> conf,dential information. . <br /> You are notified that: <br /> 1. The 9nforrrcatian you furnish will be used to det�rmiae your quatificatian far r,he permit or license <br /> resqvested, <br /> 2. You may refuse to suppty da�t,but rcfusal may require that the City deny the permit or liccnse. <br /> 3. The informatian may be shared wirh other loral, state or federsl agetscies;o the extent necessary to <br /> process the permii or liccnsa. <br /> 4. If your requested pGrmit or}icense requires Couneil action to approve,somc information may beoomo <br /> public. . <br /> 5. You have certain rights vnder M.5.13_04(available upon request)to review private data on yourself. <br /> 6. Your full name is required to procass this application or permiti. <br /> Di��. S�(�e (=�r ��A�u�.v► ��.C�.�c-�xis,�a�c� <br /> Fir9t Middit I.Aet <br /> G'Inn �.1- �C� _ `� l60 <br /> Addreys '-'^ <br /> ���U:f1o. �� �33'1 c�-�a�-�S� <br /> c�� suT� z�P raoo� <br /> I understand my rights as��caced above. <br /> ��-' <br /> �ignature ' <br /> M 32 <br />