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MAY-14-2007 11:25 From:6512030554 Page:1�1 <br /> i�y-19-Yool iD:51 w From-CITr 6F OAONo �e522dYe616 T-OTI P o0Z/0o2 F-006 <br /> . <br /> � <br /> s«.u.o+�etct�ss o�svsr�crs oF a,�Y,� <br /> S�od. 1. 'r�vf ia�a. The�`bu o�individual oo wpom mc d��s is s�n3 or a bc smRd s6W be as se�foRh in�is,e�cdva. <br /> SuDtl.3. {oto�maesao roqttltea cs Ee�.m IYdMd�l. �►n mdi•idy�1 ssted e supplY Priva�or contdeoo�l d�n coaceraiat himiel(shut <br /> ya in�oraed elr (aa d+e PurPore sa0�Oe¢nCed Ym ot Qs��sqyrsqd daa•imto�e oollCcuo;�m¢�gexy.poliacal SYOQIVIl�00.0�fO�Wido SySTtd4 <br /> (6)wAe(11e�11�R1sy 1sNse OT!S IeSi1iY requi�ad m mpply�he eeaueseed daa:(c�any lmowsi eoanaqueece a�;sia`tsv�his supplYlo�or rcl�s�ns w�uppiy <br /> privax or eonlidenda!dw;.e�(d)�e ideaaty of odrec peRoat or eaddes w�onzed�y saR ur tede�l t�w ro re�aive tl�e dan. 7fu.s nQu'aeAeer aean <br /> ,ros aD01y wt+e��n'v�d'nidu4l is axted a supply 4wead9ad.e dao.pu��re�eeeee J3.87.sybLiviiien S.w a Isw enloceemenc ank�r. ' <br /> 7he ee.nnSss�ener af rev��ye mav_py��!the nottee npyiKd�ndic�hia sv6di•icion in Ihe indiry��l inen�vy s�q�pp�Ry p= �tiwa <br /> j�}�sYecie��in9x�a or op mon Portns. <br /> Subd.7, �w a d�e�6v mdi�Idua1. Upon ieqa��w s�espou�iele aamoriry,an ioewieua�sesu ea Weem�a�red�eehe is me:ue�cee <br /> etsesred dam en indlvid��b.Oi14 MIIi�fC IL it CIy�IEKd i7 pYbIIG,p�wr of con�idepdat, Upen hts N�ef reqYss[.�0 lapivap�l W1fp Is me fubjee� <br /> af seorod privacc oc pu6lic d■a on iodirid�uls shall be�hown uie ean w�zeue aoy eauge�e I�in W:u t�e deHses,sh�11 be in6o�ot mo coo�en� <br /> ind meanins o[rhu da�a. Afur an IndJvodnal Dat oetp i110w11 tl1t Ortyit E��nG infocmed of its meSOio/.me Aan peee mt be diulo�eed m bin+kr <br /> sia nwn�l►s dureaRer unle:s a dispuee or�cdop pYtav�nc ro mis aecdon is FendMg o�addidoael dsd on Ne inaiviau�l eee been wQeered or creued, <br /> T�e rotFronsioie�u�oriry shall pto�ride copks ol Qrc Drivtic or publle dan cFon nques:py�a individu�l fuqjeecof ehe dxn. R1u re�pon,c�ele.�+ha�ip/ <br /> may roq�ir.d�o fequesein�oer�en re pay d,o�caNl cos�t vf toakinE.ecr_YiaE.and cac�pa6�y�be cvpia. <br /> 'l1�c responsible audrorip�sha11 comply IR�ooe4i�iely.if pe�sisi:.vlth�ar r_que.x<<mde pu�sua„c ro�is w0aivmen.et w;d�in f.re dsy�ot <br /> tfw d�r oP die mquai,excladhy a�Kraays.Sw�E�r:ana ur�eoiways,if i�ameafa�s oompfnoce is no�poasiete. v ee eanuoc oomoty aid��e eenurs� <br /> Wi�hLi dtae duae.Re shall to 1Nfol+n tAe inA'widud.�ne ensy hav.�sn oddieemt Prve days wi�hin w6ieh ae eeroply wim r�requosc.e+ccludiqg Soauday�, <br /> Sunaays a�ug��notW�y�. <br /> 5ubd.4. Aroc�dun�6ea data'{{,a0�7CCYT'i�E oe eem�plete_ �.p ipEjvldux!myr eenteu 01R�ecu�a;,y oecempleart�eqtOf publie�r pri��p <br /> dw�eneernin`A�mself. Tv e+ureise�his rlgEc an ineiriduoJ ahdL noalr c.,iiins he reayvn�iblc wWvrip�de�n3iu6�tu peauee 0!Ofa�p�eemeoc. <br /> 1Le rcsp011s13k audwrity shtll wilhm 3b dayi eINCC ��)temt�tha das found o�be itutevqtt or incomple�e aAd abemp[ro oedly psst neq�qnu of <br /> io.cruww or incompleoe aou,ivaluCing r�aelpiena aamed by pee bqi�lAul:oe(0)eoG�y qft�ivfidYd CI��NC EeilCve�We dua 1�be ooruCt. D�o <br /> in dispuoe shall be diselesed ody if ttM o�di�idu■l'x�utt�mene of disa6resr_:nc is i�xluded wi��6e disalesad�ts. <br /> 71K daemiina�ion oF�he responsiWe aurho�ry mq be sppee;�pu�suu��o Y�t➢1o�isio�of IA�adadeiceariva proceau�e■ci rc4dnr ao <br /> Centls�ld lails. . ' <br /> �T,�► �1tIVACY AD�T��� <br /> In accocdaace wi�h M.S. 13.04,S►ebd.2, •Ri;has olsib�ecw oi da�s".wc woald likc w infocmyvu tha�yov�reques� <br /> fec a pe�it or (�eensa !rom �he C;ry of Oroao�:�ny of iu depar.�oais mey rvquiro you co tumisti ccnoin priva�e or <br /> confideecial �nfo�asrion. <br /> You a�ce notified tbar <br /> 1, 'Ytie 1n�brmazion you Purnist�will bt used to da:zrmioe}quc qua11t1caclom tor tA�pe�mli or licenRe requesced. <br /> 2. You raay rc(use �o supply da�a. bu�refrssal m�y repui�'e �he[�IIe Ciry dEay tbe pet�oOAt o!licc�asc. <br /> 3. The irfformation�tay be sharect wi�h o�cr Ixa],s[a�e or fedetal a�eacies to the ex�en[neces�ary on process <br /> tbo portaic or liceaso. <br /> a. If your request.�d pccYa;t or lianse requiras Cotmcil ae�ion �o approve, some inPormar�on rnay breome <br /> . . pu� blip. . <br /> 5. You (u��e c����� righcs �ndu M.S. 13.D� (availnblo upoo requct� co review griva�e da�a on you:ulf. ' <br /> 6. Your full name is cequired ro proces� :hia aeplieA�3oA or rern�i�. <br /> Yl� � <br /> uu ' d!e � � <br /> Addres� <br /> ���,���t�:c-.. , ,�✓J�r/ .�'��.�`�� �..�r�„�-c�/�� <br /> C:q . Saa Lip Ppuoo �— � <br /> T unds�s��d my 'gb�s as stated above. <br /> SynaMrc <br />