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Sap-25-2000 08:50am from-CITY OF ORONO +9522494616 T-660 P.003/0�3 F-509 <br /> t . . <br /> . se�.��.04 ItIGIi7'S()F SUB.fEC'I'S Ol�b.�'I'e <br /> 5ubd. 1. '1'y�al eiara. 71�t�RghLs of individual on wftom rhe data is s�oted or m bc staced shall be a�set fo[th ia this secrion. <br /> Subd.2. Itlormation reqtrired�u t�c�en iad,iv�dy�l, pn iud�„�dual sskcd to supply privare or ronfideacal dats coocefning himselP s6al] <br /> Dc infonn�d of: (a)th.parpo�e sad ier�nQcd use of�e requcsiul d�a within tl�e collecripg;rare ar�ney, polidcal subdivision,or startwide sys�cu�- <br /> (b)whcrlser he may refii�r ot is Iegallr�equiirQ co suRDly ihe�eques�ed daa;(cl uty��nwn coasequeace arising fr�m hic a�S,p�y;n.g ar�furing►o:vppty <br /> privaLc or eonfidenoa�clara;and(�[he idearity ot'arAec perspas or entices aurho�i2ed Ay s�are or federrl law eu rR�ive rlie daca. lhis requ�rcrs,ea�shal! <br /> apc apply when an individual is aYicad ro supp�y invesegacvc dara,p+�rn�anc io seccon 13,&2,subdivision S,cv a iaw enfor�emznr�ffeer_ <br /> The eommissioner af revern�e �Y.IY nIt!!P �hr��npr_r rea�ired uncler ehit tvbdiv;c;on �� �a individuol inanM� rak oc Dio�iilY [�:t Ccfu_�( <br /> instn�etions inSte�R n�Cn those torms. ' - ' <br /> S�xbd.3. Aa:r�s to dow by iadi�iduaL Upon rc�ucst ta a respoasiblc aa�oriry,�i��adi�;dva!shaIl be informed�vt�ethor he is rhe s►tbjecc <br /> of�Tn�r�dac�on inaivi�u�lr,acid�hethee ir is elas�ified a�publie, privat�or eonGdcnaal. Upon his fur�or teques�.m u��i.i►Lual who i�rhe subjCCt <br /> of stoctd(�rir��C of pvbliC d�Gl op iqGividusis;hal1 bc strown�he daa witho�e�iy chat�e io him and;iEt�e dcsir�s, sliai� bc infarmed of flto concenc <br /> snJ meaning oE�har da�a. ARersn individuat pas bcen shown fio privace dan anQ informod oE irs meaaing,thc darn need oot be disclosed ro him Poc <br /> siz moaths thCtrsftEe un;rss u dis�.�urr nr n�pon porsuant eo dais sc�cinn ix prnding ot addiQon•d1 da�i on the uldividual bas beeR toqretcd o�ercs¢d. <br /> The reapvnsibla authoriry shnll v�u�iJc wpi�a�f�ie priraee or puDlle a�ca apvn Iequtst Oy rhe I1tG1v14ua1 suujec�of U1e QB�. 'l�ne respon4;ble authoriry <br /> may rrquire th�eequeRri��g person ro pay�he a�mal cosr.s af�rraking, ceraFying,and compiling che copies_ <br /> '�hc�espoasib e authoriry shaA comply i mmediacely,if possible,with any Rquesi made punuant w this s�eddivision, or wichin five day�oP <br /> R�c daa of�hz nques�,ex:luding Sanirtlays.5u��days and fey�l 6olidayy,if immediate compliuue is nor possi6le, ilbt catwot comply wid►di�roquert <br /> w[mut u�ar lime,ne snau;��inio��n u�a md��iduaJ,and may have:,,,addiuooal five days withir.whieh ro e���ply 1���e reques[, exetud�a 5aardays, <br /> SLrsdays snd lcgal holiday�s, <br /> Subd_4. Proc�edure wheQ d�ta f�nac accurate or complete. An indlviQunl may corttest rhe azcaracy or comDlctenoss eFpuhlic er privarc <br /> dam con�eming himsetP. '�n eztr�isa ch;s righ�.�n itidividual shsll noufy in u�riung d1c�esponsiblo ainhonry describing d►e namn of�h�di���;,ecaunc <br /> 'Ilu respons�ble aud�oriry..hall Wi�hin 3D days ei�er. (a)correcr,h�eaa faund w be inaccuca�e or incornpi��e and asump�[o n�dfy pas��ccipieats oP <br /> inaecurare or incomplere d», including recipien�s named Dy iLe indi�idual;or(D)nodPy ehe individual tt:a�he believes che dat�tn De�orrec�, Da� <br /> in disDu�a sha!!bc disclo�ed oniy iP the u:dividuel's sr�tern�n[oCdisa¢ctemenc is included with the dis�losed Aara. <br /> 'ITie dererminaq�n oE rhe rrsponSibin surhoriry�n�y be appenled pursuanc ro►he prov�sions of[t�aUminisqac'sve proccdure ac�zefIIrins m <br /> cpnut.�rd cas�s. <br /> DATA PRI�ACY ADVIS�RX � <br /> Ia accord,�nce wi h M.S. 13.04,Subd.?, "R.ights of subjzc�s o�da�a", we wwld like�o inforo�you rhat your requ�er, <br /> for a permi[ or license fco►t� [tie Ciry of Orono or any of.irs ciepanmenrc may rP�uire you co furnish cenain priva�e or <br /> confidenria] informauon. <br /> You are notifiod �har_ <br /> 1. The infoimaaon you fum;sh will hc used to determine ynur qual,ifcation for the permit or Iicense requested. <br /> 2. You may refusa �o supply daca� buz refusa! may requin: �bac [he Ciry deay [he permit or license. <br /> 3. The informacioc�may De shazed with oc6er local, scare or federal agencies to�ht ex«u[necessary ca process <br /> rhG pernzit or licease. <br /> 4. If yaur.requested pettni[ or ticrnsc aequires Council action to ap�cove, same iaformarion may become <br /> pe�blic. <br /> 5. You have cercaim ri�,hcs andcr M.5_ 13.04 (availabl� upon r�quest) to review �riva(c data oa yoursetf. <br /> 6. Your full name is required to process this a�iplica[ioa or permit. <br /> �-c�-���. ���'��1 ._. ... °�� 1 S . <br /> �-�,�_ ,�'1�V\� 1 `, �ddle � <br /> �` S ��S '' 1�� ` ��� 5��"53-� �a�-�t��c, 1 <br /> Ci 5�u Z;p Phone� <br /> �imd rst d my ri�lrs sca d ove_ <br /> .� J `r,G' t� 7�. ----� - - � <br /> S' naa�r � <br /> E/£ ' d 0689 ' ��I 0060-ti68 (Zl9) NW S�3N�IS30-� WHZl � 8 OOOZ ' 9Z ' daS <br />