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': E,�$-Z3-2001 08:23am From-CITY Of ORONO +9512494616 T-685 P.003/003 F-617 <br /> � <br /> Sec.13.04 RIGHTS OP S[tBJECrS OF DaTA <br /> Subd. 1. 1'ype of data. 'nu righss of iadividuat oa wbcw C�e dan is swrcd or m be sr�rrd shait bc as sct fosh in this secdoo. <br /> Subd.3. InYormatioa req�red to be yven iadividual. ?„i iadiridt�ai asktd to Supply priva¢or confidcadal data coaceroing himsclf shall <br /> be inlotmed of: (a)thc pu�ose and iaceadal use o!the►equesmd dan wi�la du coUecong Snte aseacy,poliocal subdivisiou�or sncewide aysrem; <br /> (b)whesher he nssy retusc ot is kgaUy mquimd eo suppty m�:equeseed 3an:(c)anY imowa wnsequeace xrisiag Gvm his supplyiag or refusa�g to supply <br /> privace or wandential dan;and fd)�he idenary of orher persons oreeaaes au�horized by s�su or federal!aw[o mceive�e dan. T�is requiremeat shall <br /> not apply whcn an individuaI is ssled to supply invesagsdve dan,putsagat w seccon 13.83,subdivision S,w a(aw enPorcemeat officer. <br /> 'T'he eommissioner of_[�•enue mav oface fie nodce irrci unde�dtis suhdivision iti die i11d'Ivldual inceme mx or uroxm tax nfund <br /> instNCti0e8 ins[� of on those forms. <br /> Subd.3. access to data by iadividual. Upon rrquesc to s respoas3le au�oay,ea individaal shall be infona�d whe�6er he is she subjecc <br /> of swred dara on iadividusls,and whed��r i�is clsssified u public,pnvace or eoafidendsl. [7poa his fuc�er r�quesc,ea iadividua!who is rhe aubjea <br /> oF srered pdvau or public dara oa individuals shall be ahown the dan.widsouc aay charge to him aad;if he desires,sball be informed of mc coaunc <br /> and meariiag ot�hat dssa. Afur an individual has beea shown che private dan Ynd infotmed oP irs meaeiug,du dan aeed not be disclosed oo hisa for <br /> suc tnondis d�ereatur unless a d'upuce or acdon purawn��o:his seedaR is pcndiag or sddidousl dsra oa ehe individual 6u been wltected oc crcared. <br /> T6e�esponuble au�horiry shaU pmv�Qa copies of ehe privace or publit aaa apon ceques=by�he individaal subject ol the dan. The responsible authority <br /> msy r�quire�he requudng yarson co psy d�e acn�f cosrs of maldng,ccrdfying,and comPilinS rbC epp►�s. <br /> Tha responsible aurhoriry shalt comply immedntely,if pos:�ble,wi�aqy mques[ntade pu�suant ro shis svbdivision,or withia five days of <br /> she dau of rhe requa�exclndiag Saeurdays,SuMaya and legat holidays,if immed"a�e compliance is noc possible. If he csnaoc comply widt du request <br /> within�ttac tima.he shail so inform tba iadividual,aad nny have aa adli�ow�l hve days wirhin w6ich to comply wish the requesc,excludiag Saturdays, <br /> Sundays and lega!holidays. <br /> Subd.4. Proeedui e whas data is aat accucata or eomplete. M individual u�y cotuest the acatraaY o�eomplereness oP public or pri�acc <br /> da�eoneemins bimsell. To exetcise rhis right,an indiridual shall nonty in wridng the cesponsible antlwriry describiag�he nature ot the disagreemcns. <br /> T!x sesponsible au�heriry sball wi�liie 30 dsys eithec (a)consct she aam found ro be insccurau or lncomple�and aacmpt w nodiy past recipienss oP <br /> iaaccurace or incomplece data, inctuding recipieaa nattud by du iadividusi;or(b)no�ify the individunl rhac he beliavas d�s dasa�o be cornec Dan <br /> ia dispuce shal!be 4isclosed only if�he iadividual's sneemea�of disa��reemen�is includad wirh�e disclosed dara. <br /> The daecminadon of�ha responsible suehoriry may De apG.e�led pursuaac co the provisions of thc adminia�arive proceduce ac�nladng w <br /> eon�esxd csses. . . . <br /> D T_A a PRY�ACY ADV;SQR'Y <br /> In accordauce with M.S. 13.04,Subd.2, "Righu of subjects of da[a"�we would like to inform you that your request <br /> for a permi� or license from the Ciry of Orono or aay uf iu departmears may require you to furni.sh cenaia private or <br /> coafidentisl information. <br /> You are noiif ed that: <br /> 1. The inforaia�ion you furnish will be used to decermine your qualification for the permic or license requested. <br /> 2, You may refuse to supply d.ata, but rcfusal may require that the City deny tho perm.i� or license. <br /> 3. The inforniation may be shared wich orlier 1oca1, s�a�e or federal ageacies to the excent n�cessary to process <br /> rhe permit or licease. <br /> 4. If your requested permit or ticenst requires Couacil acuon to approve, some 'saformacioa m�y beeome <br /> public. <br /> 5, you have cenain rig.ttts under M.S. 13.0� (availabte upon request) to review private daca on yousself. <br /> 6, Your fuiI aame is required to process thii applicatiou or pernut. • <br /> F�n� �tidiue 1.asc <br /> Address , <br /> Ciry Sn�e Zip Phone . <br /> I understand my righu as s�aced above. <br /> ' �� ,n.fra�c�✓ <br /> Signature <br />