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hov 16 05 03: 40p D 6 J STEELE CO [6121728-9961 p. 2 <br /> Sa.13.Q4. WGf17�QR 3�1B�CIS OF DATA <br /> SuDd.l. Type ot'dera 71ie rights of individual on wd�om the dan w�taed�w De slorsd e6W be sa aet fath in thie aearon. <br /> infamod of�.�tl�c purpox end inoudal�nc ogf�be ueslad dNs�ihin t6c�U s!ffie�aieeo6deB�l dtfs 000CC�Ap1g h�e1f�18i!be <br /> � 'O� �B �Y�P�i[fCal SubdiVlslort,Ot st�ewlAe sys6e+r+:(b) <br /> whetl►a 6e may reflue or is k,gal��equired oo s��pply the�quesD�d data;(c)v+Y tnoam concequence ariso�g ttao his w�plying br ie�usiiig to suppty <br /> �ivMeoroonfida�tialdw:a�d(d)ihcidentityoPo�pa�w�sarmwisamhur�dby.�oaorfbAatllawlo�exiveWed�Thia��IWi <br /> noE appty whcn an indivi�al is asi[ed m s�P�Y m�����.P�m section 1�.82,wb�vision S.oo s I�w enfaoement MFioe�. <br /> Tbe ooe�miaia�er of tnrr�v�e nwv nleoeahe notie�_�irod u�der d�s n�h�visien in tl�e in�vid�ei o+eorrie tax or n�aoutv� +�'...+ <br /> in�i'gns ins�eed of on those fotYin. — <br /> Subd.3.Acoesbdrlabyedivid�el.Uponteqao�tma�espoas�suho[ity�mmdividud�hallbeicTormodwhAherh�istlxsultje�toF <br /> f0aed dela ao iodividu�k.aod wheller it is dauitied as public.Privaae aroanfideotid. Upon his fmtber�aqupt.an u►dividu�f who is d�a subje�x of <br /> storedprivste or�blic Qa1s�mdividu�ls dull be ahown tl�e data without a�iy chsrge w him aad,if 6e dwins.shall bc mtarmed oftlb 0000rau aod <br /> mdaioe oftAet dats"ARer m iodividusl has bem ahown�he privaoe daos and infarmed of its m�aoies,l6e dw need aot be discicaed to him for aa <br /> anathf d�alla uokss�difpuro or aetioa prsu�nc to this'o�ioo b pa�dios ar addiriarl das on Aie Ldividwl has bo�e oolkc0ed ar ae�ed.7'he <br /> nspo�ible wtlwrity shalt,provide copies of tl�e privste or,public data upon mguest by d�e individiwt wbjecc of die�. The re6poosible awhoriry <br /> �'���P�*��PaY elx sctus!wa�of moking,cer4tye�,�d oo�ilin�tl�e eopie�s. <br /> T�����Y��Y�Y>uP��.���Y�9�n�P���1�swbdiv'tsia6OtvY'tlhinFiMEdrysd' <br /> �he daoe of the raJ�.��S�Ys.Su�Ys and kpf holi�y;iPuRaed'ote comylia�e i�nocpoa�3le.UDe a000tcpnpty wilh tlie nqueet <br /> with�shrt Wne,he 5hd190 iMo�m the individud.oed�orp h�ve aa additioed five dsys w+�6in w�6ic6 ioaomply witli d�e�equat,exd�dmB S�prd�Y� <br /> Sw�ys and lagal(alidsys. <br /> Subd.4.Pr000d�aowhendstabootacaaa0aorooaqleaG Aamdividustnmyoanmttlie�ocros�yoraomple6enessofpublicarpriv�edem <br /> 0000ani�hinsdf.Toawei�elbatil�t.aomdivi�d�ilmdfymwriting�he�rblea�ahoritYdna�ing�eertueoft6edisa�eoma�t 1Lo <br /> mspo�ibk sutfioril.y ahdl within 70 mys eitl�: (a)ca�ou the dela lamd oo be i�oauate or incony9eoe and a�am,pt to owifypast�eciD�'eu�oC <br /> ioec�auate or aoort�pleoe�ta,iocluding rocipierAs named by the iadividual:or(b)nodfy dro individuei tltat 6e belie+�the dela Co De comect. Deta in <br /> d'npre ahdl be disdo�a�d only if We individud's uuar�e�t ofdi�gneeeptt a mclludad with We d'nebeod dare. <br /> 'fbe detamimaon offhe t�spoasible authoriry maq be a�esled.pu�uaot t�tlie prov'sions of the ad�oudso�ati�eprooediue act robtieg to <br /> ConitSted�. <br /> DATA PRIVACY ADVIc_��DR� <br /> Ia 8CC01'+�B�OC'WI�1 M.S.13.04�S4�2f NRl�Of SnbJOCt3 OF�hI°�WC WOY��(IICC t0 IIICp'EIp yp11�18C�p1�� <br /> for a pe�mit ot license&vm the City of Orono or any of its depm�e,nts mey�equire you to furnish�n privabe or <br /> confldential infonnation. <br /> You are nodfied that: <br /> 1. The infornzation you fiun'ish vn'll be used to detcrmine your�ustiSc�doa for ti�e pem�it or ticense <br /> �N�- <br /> Z. Ya�mspr refuse bo supply data,btrt cet`asal m�r req�nre tfiat the G�ty deny the pennit or license. <br /> 3. 'I�e informatton m�y be sha�ed with other Iaxl,state or fcdersl agc�cies to the euoent nocessary to <br /> �oce�tfie pennit or iicense. <br /> 4. If yo�a cequest�ed permit or lioenx nquiies(;ounci!a�.tion tio appe�nve,some tnfoRnation may b000me <br /> public. <br /> S. You have oe�tain rights under M.S. 13.04(available upon request}oo e+eview privabe data on youiself. <br /> 6. Your futl name is required b p�ooess this applicstion o�pecmit. <br /> '17C a�.�41,D y 4 A�• 7�=GC� <br /> � �►llddle . I.ast <br /> 35�� Zv'�` �-✓6 - �, <br /> Addrep <br /> /�l'P'�S /la'�l `v 5'�7 <br /> �4 ssw� z� re� <br /> I under�stand my rig6b ted above. <br /> 31p�t�re <br /> . "Reset T6[m�' . 32 <br /> � ._ . <br />