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CRRGTLL - BENEFITS Fax�952-984-0500 Rpr 18 2006 11�09 P.02 <br /> Sea13.o4 RtCH'i'S OR SUB�CTS OF DATA <br /> 5ubd. I. TYp�of deta. The[ight6 ot Ipdividual on whom�e dals is eoo�d er to bo atored sNall bc at Aec fbrth in thi6 sOction. <br /> sub�,a. 1�!'orn�oe�w+req�i�d w he aiven ind;vidu�l.An individual aBkad w SupP�YPr��or wnfidemisl dan conceming himself�all hc <br /> inrorm�d ot` �a)che vurPoec and intcndad wo of tfie requested de�a within Ihe collccdng statc agency,pciicicai subaiviaion,or sv�cwide a�s�n;(b) <br /> whaher he msy reFute or IB legally roqulfEd TO SupplY���Q�S���:(C)�y��c��qucnce arising from his aupplying or ref�sing to auDP�Y <br /> privoee or confidential d�ta:and(d)the idcn[ny oPoehcr porsens or cneities authorixad by smte or fodixal law w re�xive thc clnta 77iis r�quir�o sl+sll <br /> noe apply when an individual ie asked to aupply invcstigativc daw,pvrsuant to aection 13.82,subdivision 5,to u law enforccmene officsr. <br /> The rnmmiset er ot c� e <br /> , ;v;aiQ�j}��e.l;v:r+.�sl Inenme eeY ur�o�'dtv tax R��nd <br /> �nrinnv instesd of af1 f}fOBC�4LIDs• <br /> Subd.3.AcceS9 to dsta bY��Ividual. Upon fcquestlo s�cepunaible audwrny,an individual shall be informod whether hs is dic eu4jaceoP <br /> g�pt'CO dete pn indtvitluuls,�+d whcther ic ia elnasified ae publie,privatc orconfiden�inl.Upon hie t�td�er rcquest,an individuol wHo is the`ubject oF <br /> stored p�iva6c ot public d9L9 on indiviQuala sholl be Elwwn the data without d+Y�wrge t°him end.if he desires.shall be infam�ed of thc contcfn a� <br /> meanins of thac dake, AftCr an individual has been shown lhe pcivs�dots end�nf�rmed°f'��'°'&We data noed not be di6closed to him fo�six <br /> nwndv thereaRcr unless a diapub9 or acNon pursusnt t0 lhis sc�tion Ia pcndin�oc addidonol ds�s on che i�drvldusl hws ae+n collco�od o.�resoed.The <br /> roaponRible authotiry ehall prov►do t�pies of th�Privstc ot public data upon raquest bY th�individual aubjeet of[hc dam, The rosponeible suthority <br /> n�ay rcquire d�o rcquestinB Poraon w pny the ach�al coats ocmnkin�,cortitying,and con+plli��d►a voPica. �ysoF <br /> Thc r�sponsiblc wnhwiry el�oll comply immediatcly,ifpossible,with anY�4uest madc pursusnt m chis subdivition,or wimin five <br /> the daw of thc requesk cxeluding Saw►daye.SundaYA�d legal holidays,if immectia�c wmPliaaco is ra[poeaibla.If he cannot eomply with rho requoet <br /> withia�1+at dme,hc ahall go infom+�+c indi�idual,and meY����d�uonal flVe days wllhln whicfl to ComDly with Ihe rcqucst,exClud'Ing SaturtJ�ys, <br /> 3undaYs a�►d legal holidays• <br /> Subd.4. Procedurc wnen�am is not accurme or vomplc�.M iedividuol n+.Y���+•�uracy or complctcness o[public or privsoe dsti <br /> conc�ming himsclf.7o cxcrci�e this righ4 on lndividual shell noriry in writingthc�apensiblaauthoriry dcsCfibing the nsture ofthe di9sgRemeflt.The <br /> reap�uuibla e�horiry shall witNin 10 daYa aicher. (a�oonees eh.data found to bc inaccursu or inCompleas end ettempt t�nollfy pssc rccipieMs o[ <br /> inseeu�sce or ineom�lecc dnta,including recipients named by d�c individual;or(b)noriFy ehe individuel th�t hc bclieves shc dala to be co�rocc. D�ta fn <br /> dispute ahall De discloeed onlY�f the indlvidual's 6tstement of Aieagroomc�n is Includcd wi�n d+o dieotosaef daia. <br /> The detcmtinadon of tho�ponsible autho�iry msy be appcalcd Pursw��w�he P�'�"s'�a of�he adminisnaeive proccduro occ relatin�to <br /> oontesoad cs�es. <br /> DATA P iVACY ADV(SORY_ <br /> In accordance with M.S.13.04,Subd.2,"Rights of subJects of data",wc would like to inform you that your request <br /> for a perrr►it or licensc from the Ciry of Orono or any of its dcpartments may require you W furnish certa'tn private or <br /> confidential information. <br /> You are noti�ed that: <br /> 1. 7'he Informatlon yau fl�rnish will be uscd lo detoemine your qu411flCation fo� the permlT o� IiCCnse <br /> rcquestcd. <br /> Z, You may rePusc to supply data,but refusal may requice that the City dcny tha pcnnit or liconse, <br /> 3. The information may be shared with other local,state or federal eSencies to the extent necessary co <br /> prooess thc permit or licenae. <br /> 4. !f yaur rcqucstad pernut or lieense r�uiras Counei)nction to opprove,some information may become <br /> publtc. <br /> 5, You ha�c oertain rl�w unde�M.B. 13.oa(uvailable upon rcquaat)to review privace data on yourself. <br /> 6. Your full namc ia required to proe�as this epplication or permit. , <br /> .�•' / d � �rn� <br /> ��. <br /> Rirst MWdlc � <br /> 6 0� C r'��.Ss <br /> Aaure�. <br /> � .s"�3 � <br /> City sbce Zlp Phnne <br /> 1 underst�nd my rl�hts as atatod sbove� <br /> :. <br /> Sianscuro <br /> .............:.::.._::.:�<<:���:;�...,.•:•::;:�:::�;:;;::�::.;;;.:::•;:�•...:;:; <br /> �:;;;,:�'�.::;.,:',;;;;::;:�:::;�.eAei��?a'rTnt:;';:;:�::::::':�::�;;::?:;. 32 <br /> `:,.�:.,.:;': � ...., �....:... ..:...:.::::::a:•:+t�t�":;i': ` . <br /> •.' :�.�•�. <br /> ;U�::..x...�r�•..y��1x��l,::i`V��...... ....�:...:. .. .. �..1 y.' <br />