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Feb-25-2002 03:43pm From-CITY OF ORONO +9522494616 T-752 P.003/006 F-491 � . , Sec.13.04 RIGHT'S OF'SL�3.J£CTS OF D.i'CA Subd. 1. rype o[data. Thc righu oF individua!oo whom the daa is srnce��o�w bc swRd shall be as sec[orih in ehis secrion. Subd.2. Info�nali4n teqtured to be pvw(Adiridval. AA individual�slced lo supply priva�e or eonfidentui dan concetning himsdf ahall be informea of: (a)�he purpose aad inmaded use o(��quasv.�i d«a wiehlia�t+e coUe,:dng Snrr ageary,potidcal subdivisioa,or smt�wide�sum; (b)whuber he may�zfuse or is legally rcquired m supply the►equared dam;(�)�Y�w�a coosequenee uising from his ivpP�yiog ar tefusiog to suPP�Y , private or eonCdendal data;and(d)rhe idcndty of othcr persons ar eneiaes au�harizcd by:ictc o�fcderal law to receive�e dan. ?his�equiz+emenc shall aot apply whea an individu3!is askcd to suPPly invesdgaave data,p�irsuanc ro sceGon�3.82,svbdivisiou 5,to a law caforteuuat otficec. 'ilfe eartunissjoner of revenue mav olace the nodee repuired undeC this subcyivision in che individual ineome rax or vrov�m_tax_rcfund �nsttucdo�s insread of on those fonns. � • - Subd.3. Access to data by iadindual. Upoa rcquest to a rospansiblc autho�iry,an iadividual shall be info�med whe�her he is�e subjecc of stor¢d data on individuzls,and w6e�her i�is cl�ssiFied u pu6lic,piivacc or conFd�nwd. Upon his fu�shcc roqucsG an iadividual w110 is the svbjeu of sw�ed privare or public data en i¢dividuals shaU be s6owa thc dau wi�ftou�any charvto to hi�n aad,-U he desices,shsll ba infacmed af thc coatcat and meaait►g of thac dara. Afur an iadividu�l has been shown d�e p��are dao and inforraed ef ia mcaning,thc dara need no�6e disclosed to 6im for siz months dtereaher uNess a d'upure or accon pursuanc m this secc��n is pcoding oc additioaal da�on►he iadividusl has boon couceoed oc ereared. llie responsble auchori�y shall providc copics of Ute privatc orpu6lie dan upon nquesc t�/thc individual subjea oC the da�. 'Ihe responsib�au�horiry utay�tqu��e requcstiAg pecson to pay thC ictu�cos�oP makiag.cc�tifyi�.and cnin�il.ing dte copics. The responsiblc authoriry shall eompiy iauiudia�ely,if po:siblc,wieh aqy rcQuest made pursuant to this subdivuivn,or withia five days oP the daie oP the rcquesc,excluding Saturdays,Sundays and Icga1 holidays,if imiacdiate cornpl�ancc is natpossibla Ilhq canno�comp�y wi�h ttu�sques� wiehin thac da�c,he shail so inforra thc individual,and may havo an zctdiaonal five days uri�in which to eomply wi��he teques4 exdudiag Sapudays, 5undayS and legal holidays. • Subd.4.�R�aecdure�rhea data is nat accurate or cqmpl�_te. An individual�t�ay eoo�est thc aecu�aey or eompleeeness of publie or pri�acc dats eonccming himself. To czcreise rh(s righG an individual shsll nodfy in wrien8 thc n.sponsible au�hority dacnl�ing the naaire of the dlsagreemen� 7ho responsble authoriry shall wirhin 30 days eidte� (ap ca�cec[�e da�a found ro be in.�ecurate or incomplece and aaempc ra nodPy p�recipicna oE inaccurate or incompk�e dara,ineluding[ncipien�s named by ihe individuel;or(b)nodl"y the individual that hc believcs thc dala to bc eor�ec� Da� in dispuoe shall be disclosed aNy if du individusl's statcment oE disagrceroent is inetud•�d wi�h the disclosed da�a. ?he decemut�adon o!du rapon�ible au�horiq tnay bc appenled pursuaat oo�the provisions of tha adminisuadve procedum acc nlaoag w conoosred eases. • DATA PRIVACY ADVI ;t�RY In accordance with M.S. 13.04,Subd.2, "Rights of subjec�s of daw a",we would like to inforsnyou that your request foc a pernut or license from the City oP Orono or aay of iu departme�its may require you to furnish certain private or confideatial information. � You are notified that: ' 1, The informa[ioa you furnish will be used to de�ermine yoe�.t qualification for the permit orlicense requesced. 2, You may refuse to supply data. but refu:�al may require that [he Ciry deny the permit or license. 3, The information may be shared with other local, state or I'.ederal agencies to the ezteat necessary [o pracess [he aermit or license. 4. If y0ur reques[ed pennit or license requires Councii ac�ion to approve, some infonnativn �ay �::.ca�e public. �, You have cenain rights under M:S. 13.G4 (availabte upon reques�) to review privace data ou yourself. 6,� Your full name is required to process this application o��permit. ��-��- � � First M�ddle �t �� (.i � S�{i -�� '�V Z /�' C Address ��/� l ti ; c = r��-= _. �s:.�c� % 7�.� y-Oc��n Ciry Sm�e Zip Phone I understand my righcs as st3ted above. , C:� � �� ._ 4 $I R1tG