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Oct-18-2004 10:08am From-CITY OF ORONO +9522484616 T-023 P 002/002 F-48T <br /> See.i3.04 ItIGHTS OF 8UB.1EC'iS OF DA7A � ' . <br /> Subd.1• 'lype ot dst�- '�ee rfghu o[fndi•idnal oa wkom the datx�s��or to be stored shsll ba�s Kt forth fn this satioe. <br /> Subd.Z. Iatorn+�tion tcvlu�rtd to be gtve�indMdu��-Aa indivldu�l�sked to�aPA�Y P�te or eonfidealfa{dat��onarnlnr himftlt s6a11 be <br /> leformed of: (a)tbe pyrP�s�lotended uae o[tfie requested data w�khia tUe toUcrtlng stste agrncy,poucieal�ubdivielon.os su�ewlde system:(b) <br /> whether bc may re(aa or is fegsffy*�q�l��supply the requated di[a;(c)s°r 1�o�"n eoeseqaeAee�rt�lnC irom hh supptying or re[usieg to snpP�Y <br /> pAvste or eoaGdentt�l dab;aad(�tAs Idendty Inveeeigatl�e d�u,P�uant to uetloa 13.S2t�sub4ivision 5.to R l+�wreniorceme t offlccr-unnent sbatl <br /> ��opphr when aa iadlvldual is ayleed�o�app y <br /> min slnnrr nven ma ce tht etice r airod der th �rhdivitl in the f dua!in e ta:or n rtv t **�fund <br /> • atrn nns ias[t oT On se for �. <br /> Subd.3. A�ws m d•n Sy�pdidduxl. Upon�q���a a raponsibk autho�b.��1p�vidutl shsll ba iatormed wbctAer he i�che subJe�o� <br /> atored dit;on oN+dvfd�dats oe fadlvidaals shau be sAo■A dau withou�.ay cbsii�c�to hlm and,lt Ae dedres.sEallibe iw[rened of 1u eonteat�ind <br /> atored prl P <br /> �ach�nt atur�•u puu or'aetion■pYrsoant�to enu�eet�is D d oL or�dd�nal dsc�a o�e che ladl�aual h�been coUected or errated. 'f►�� <br /> me <br /> raponNbk aatAodty shall proride ooples of che prlv.te or prblie daa upoe s a����n�`i'���?ubJeM o[the dst�.TAe responsiDk auttton a+xY <br /> reqrlro t6e reqae■d■g Per�°°m psy the actaal cofts of m�ldag�e�1O'1�C+ P g P <br /> Tht respomsible sathoriq sha11 ooe1P�Y in'°�tdlz�dy��P�ble,w�itA any requeat made persa�nt to tA{s cubd�vision,ot withia ftve days of the <br /> d�te o(tb hc�fiall a toctn�tb indlvfdv 1�a a�y bavice an�addltbnrf tive d�Y�tw h apw`ht h t co pl�y wlth the rcquest,xCIY'd�n�S1U1��+S011d�ys <br /> t�ut I�RIl, <br /> aed k�al holidays. <br /> Sub4 t. Proodurer►hen dsta k aet sceerate or rnmplete. An Indtvldu■1 maasible wthoriti perlbinc he aature ot�6e d,(sagrrc��at� <br /> rnsarnin�himrNt.To rserei�e tbb ri��an ladi•�asf sh�ll nod(y m.vrldn=the nspo ,st recf �rnta of <br /> re�ponsibk aat�rlt�'se�11 wltbio 30 4sys either: (a)corn�t the dttt:tound to be inacn+nee or larnmp��e rnd saempt to aotliy p P <br /> {�ceurste or IoeomPl��ds�+'nel�dfn���dM����d hy�he Individosl;or(6)notify the Indi�ldusl that 6e bolievea the dst■to�e conect.Daa ln <br /> dy�u s}uA pe dbclo�ed oalr ff the mdlvlda��'�statc�ept of dt.�Breemcnt Is tacluded wNh tbe d�adwed d�t*. <br /> TAe deteneio+ubn ot the�pon:lble auchorlty maY be�ppeoled pursnant to thc provlsionc ei the adminia�r�ifve proecdure act sela[ing to <br /> �ntcmd cssas- <br /> pATA YRIVACY AD'VISQRY <br /> Ia accordaace with N�.S-13.04,Subd.Z,"Ytight y f subjects of dat'",we wT ulu"ie yon�to furn sh certayn private or <br /> [or,permit or license from the City of Orono or an of its dap�trtments may eq <br /> confidential information- <br /> You are notitied tt�st: <br /> 1. The information you furnis6 will be used to determinc your quali5tation for the�t°oc i�censer.�u�ted. <br /> m <br /> Zy ouu may retuse to supp�y dat�,but retbsal may require th9t thc Ctty deny tht pe <br /> 3_ '1'he information may be shared witl�other local,stste or federal agencies to tbe eztent necessary to proces� <br /> the permit or license. , <br /> q, If your requPsted p��t or license requires Council action to approve, sorne iaformation mry become <br /> public. <br /> g, You have certain rights under M.S.13.04(avail�ble npon requcst)to review privxie data on yourset . <br /> 6. Your full naine is nquired to process th[s appiication or permit. <br /> First <br /> Mlddlc ��t <br /> Addms <br /> � st.« Z�n p�� <br /> i <br /> Y understa my rights as stated above. , <br /> -� "c►� <br /> S�nttnre <br />