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1un-1�-2001 09:28am from-C!?Y OF ORON� +9622484616 T-2d6 P.?a3/005 F-486 <br /> Scr..l3.Q4 WGF�I"fS OF'SZFBJEC'IS OF i).�TA <br /> Sakd. 1. '1°ype of data. 'fhe righa af iadividutiY oa Wbam�he daea i�swt�d or w bc�wrcd shRll�as ics i'vnh iu ttau secaoa. <br /> b <br /> Subd.2. Inforxnation required to be Eivew iadiridinl. An iaQividuyl axkcd ro ssQpiy psirutc ar couhdenoaf datn cauceming himsxif sbsll <br /> 6c iqformed oF. (s3 ehc purposa aad 3a�nded use ot cAe teques�ed dxta wi�ia Ehc collcetiay Swtc agepey.polidc�l subdivisien.or srstewidc�ytte�; <br /> (b)whcrLer tse cs�y tefuse or is(egal�y cequiasd eo suppiy t�.e requesu4 daa;(c)u+Y kaowc caascqucacc acising from his supP�Y�d or refusia8 m�+PP�Y <br /> , pivace occonfedcncal dan;xrd(tl}ihc iCend�of otl:crpersons or earioes auWorsxed by siace os fsdecal!sw to rescivc the ct�eta, '1'his nccqc:immtac sa:ll <br /> aot apply whsn an indiviQuxt is a�cced tcs ivpply invesdEaave daea,puczuu+c tu saeaaa 13.82.sabdivtsioo S�ta s Isw cutawcuuttt o"facer. <br /> Tnc cortvrissiar.er�f rcrer,ue mnv eisce the nocce wqb;w,rod ttader this subdivision fn t,hc ; ividuat irteame rtx or p�Qe�c_v_�c_ez[w:.c� <br /> ir�structions'vu�Ead o�o:�thost lortns. ' <br /> Subd.3. Aeeesc to daaa by iodivadual. Upan ee�ucss ra t respastsible auahoriry,an iadividual saatl be ir,for�cd w6tchsr he is t�iubjec: <br /> ef sarcd Qaca on indivEdu�:s,and+rkte�hr.r ic is classified is publie,private or cor�fidcn�al. Upoa hfs fvt�er reqttuG aa irdividual wbo is t�e s�bject <br /> af sto�ed p�ivar.e ar Qublic dan�an i�dividu::s shaII be shown�he dam waFhoae aay charSa co him and.`if hc Qcsizcs,ahall be informed nf ttsc caaecat <br /> aad mcaaing a�chsc daca. Af�r aa indiric�ual bas Deen shevnx�c priv�t%daa stid intortard vf iu meania�.tPae data need no�bc disclased m�fer <br /> siz mon�hs diereatur untess a Cispvre or acdcr pursuant to t'his teeaoa is pcnQlag ar mddiaona!data oe tka iadiYidca!l�as besn eoll�cc,-d os e�azd, <br /> Tho resFonsib;e au�oriry shal:provrde copies oC t�.e private aryublic dan vpon�eques�by�hc i.-�Qividuai subjcsc of thc dam. 'fhe respassibtc au�ori.y <br /> may tequire the ttquesacg pecson ta pay thc acwxl cosss of raalriag.ccniPyici;,anC cGmpiiiau�he copies. <br /> The czspens'sb�e c�croriry shatI eomply ir,uncdia�ety,3f possibtc,wi�h aqy rcqucst made pursuaszC to qhis suDdivi�sion,ar wiffiin five dsy�of <br /> t�e daie of thc rcqc:est,exsiudicig SaAsrc.+ays.S�ndnys attd iegai holidays,lf iminsdiau eampliancc is aa pessible. Yf hy ca�vt coaagly widt rha�squac <br /> withla tl.as sime.ha sball so inform We iauiiYn4ua1,auad ptaq have an additi8nal fivc day3 wi�ssl w{ucb�o eotupiy witlt th¢ltqucst,cxcludiug Saat�l�ys. <br /> 5und9yi us�d k�s!holid�ys. • . <br /> $ubd.4.•Precedure�w6e�daC►is aat accurate ar oomplete. An indiviCua�may�onust tha axuraey ur oompleuness oPyvbiic or privam <br /> dara cor�cemi::g kfmseif, Ta aXec'�isa chis nghs,an individual s4a11 nadfy in�r,nr�g�c rospestsibte ausTcor'sty doser.l9"+0$tba naaue of die disagseaaeas. <br /> Tho rrspar.3rbl<Yuthodry shsll wiihaa 3A days ci0icr. (a}eomc�thc data faurKi ca be isac:uncc vr ineomplau and atecsx�pt�acaTy puc rec;pienu gf <br /> i.n�ceursu vr ineomqie[c dau, {nc;uQ'tng ncipicnb i�amed by rl:e indiridua::Or(b)natify die"ssdividua�l�kat be btlieves che dsrs Eo be cvnsCw Da�a <br /> Sn d'upux sha:i bc disclosed aNy°f t��tn individaal��StlitlL<Jli Gl dL39ljRCtf.C6!lS{RCIuQbd�vll'h�C tIlSclo�e3 data. <br /> 7he dtutm:.'�adOn ei dit tesponsibls authvri�y tnsy De app<aled pisrsssaac w�ke provisioru vf the adminis�san�e pmeadure act ieladng w <br /> conxs+sd cssc.s. <br /> 1DATA PRIV�..C:Y ADVISO�'_ <br /> In sccorda,�ce w�th M.S. 13.Q4.Subd.2, "Rig�Zts af subjects a£data",we would lilce to;ufortu you that your rzqucst <br /> foc a pecu�,it or Iietr,se fro�tht Cic�� Qf Oroe�a or auy' of its depaz�naens may requixe yau to furceish aercain private or <br /> coafxdeaciai irtt'ormatioa. <br /> You are zlotified tklat: ' <br /> 1. The informati.ou you tumisb ws13 he used tp decerm�iuc youa qualificatean fo[ehe petmit nr]icense rtques�ed. <br /> 2. You may refvse to supp3y da�a, but r�fuszl may reqvi;e �►at the City dGny che permiK or?iceus�. <br /> 3. The infonna[ioa may be s�s�r�d e'vith other Pocai,stase or federal ageacis� ca che CXctut aec�ssary to process <br /> che pet�.it ox lic.ense. <br /> 4. �f your z�qucsced pear.ic ob IEce�se iequ�ues Couneil activu co approv�, some in�.�orcaatioa may bexo�e <br /> public. <br /> 5. You 2.avc ce:saiu �ignts ucxdec M:S. 13.84 (ayai3abI� npos requtst) Co review private data oa yourself. <br /> 6, �'our full nazn� is required co process this applicacioa or permit. <br /> ����"� �-t�'C ��r G`Y C i1_ , �_ �-'�� . � <br /> Firu Middie LLti <br /> �i._i.J.],S�. (A 1 ti��� tx��'�< <� � �� ....�.� <br /> AQd�s3 /� � <br /> �Vl� c� t�7����/ ��i�- ������ �� .�C:�<< �t`z�—`tl��y�: <br /> Cip Smcc Zip Pboc.e <br /> � , <br /> 1 ur..dentand y ove. <br /> .—..._.--� ' <br /> Signaat + <br />