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f H.rg-23-2�01 08:23am From-CITY OF ORONO +9522494616 T-685 P.003/003 F-617 <br /> ' � <br /> r , : ±s a, <br /> Sec.i3.0a RIGHTS OF SrJB.►EC7'S OF DaT.+1 <br /> Subd. i. Type of data. Tbe rig�u of individuat oa wbnw d�e dan is swcrd or m be ararcd shali bc as sct forih in this secaon. <br /> Subd.3. Wormatioa req�red to be pvea iadividuat. ,�,i iadiridual aslced to sapply pcivatt at confidcoca!dats conceroiag him�sct�sbait <br /> be inlormed of: (�the purpose and iaxnded use of rhe requeao�d dan wid�ia�6e collecdng�at�agcncy,poWical subdi�isioa,or srasewide sysrem; <br /> (b)whecher he msy refusc or is legally nquiRd eo supply me:equesrcd San:(a)atty lmown eonseque�e xrisiag ftvm his supplyu►g or refusa�g to supply <br /> privsce orconndentia!dan;and fd)�he idenriry of o�herpersons orencaes authorized by s�ak or fedGral law to cYceive tbe dan. This requiremea�shaIt <br /> not apply when an individual is asl•ed to supply invesdgadve dan,purst�ac to seccon 13.83,subdivisi0n S,rn a law enforcemeac officer. <br /> 'Y'he commissioner of_[at'enne mav elace the nodce re iies!undet dtis subd4vision i�1 dfe 'ttldividual income nx or orooem taz refunti <br /> inStNCti0t18 iRST of on chosG forms. <br /> Subd.3. Auess to data by iadividusl. tJpon requesc to a respousible au�hoci�y,an individual sAall be informed wbeeher 6e is�he subjecc <br /> of swred c'asa on individu�ls,sad whc�bcr i�is clauified u pubIic,pnvate or eonfidencsl. Upoa his furrher reques�,aa iadividual wdo is�he subjecs <br /> of srnred priva�e or pubiic dam oa individuals shall be shown ehe dara.widiouc any charge[o him aad;if he desires,sLall be infocmed af dia co�tenc <br /> $nd m�ipg of tt�ac dsm. Afur an individual bas brea x6own the pri�s�e dan and inforraed of io moaoiag,du dan qeed not be diseloud so hisa for <br /> si�c mondis d►ereafur unless a dispu�e or aedon pursusn�w shu secdon'u pcndies or addidoflsl dsra ott rhe individual hu bern wllected oc creaeed. <br /> The ccsponsib(e aurhoriry shail pr�vida copies oP�he privaa or pubGe aaca upon requesc by�e individual subject oP tkft data. The responsible sushoriry <br /> msy require t!►e requudng parson ro pay dfe ua�sl cosc�o(malong,ccrofyirt�,a�d compilinS die capir.s. <br /> Tho respot►sible authoriry siull comply immediately,if pos:tible.wi�aqy nquesz tnade pursuant w rhis subdivision,or wirhin five dsys of <br /> �he dau o!rhe requa�.cxcluding Saeurdays,S�cMaya and legsl holidAys,if iramedian eompliauce is noc possbla If he csnao�comply wid�che requesc <br /> withjn�haL tima�he shall so inform tbe iadividual,a�ttny luve a=t adJi�otul ffve days wirhai which tv comply winc�he reques�,excludiag Saturdays, <br /> Sundays aM lega!hoJidays_ <br /> Subd.4. Proeedui'e when data is aot accurato or eompkte. An individusl cnay conKs�the accutacy or eomQlereness ol public ar pm•aQ <br /> da�eoneemiag himself. To exercisc cbis dgJu,an individual shslt nar�fy in wrieicg tke cesponaibEe anNoriry dacribiag che astuce ot the disagnemc�c. <br /> ?'!�e responsible au�horiry sbatl wid►fa 30 dsys ei�Lee (s)corerct thc aa�fonnd eo be insccu�ase ar inwmplem and aaempz w nodiy pase recipienrs of <br /> inaccurate or ineomgle�e data, inoiudiag recipieaa named by�e iadividaai;or(b)no�ify du i�dividual thtc he balieves dx da�x w bc co�sec. Dan <br /> in d'upuce shsll be diselosed only if die adividual's seaeemene of d9sa�{Mernrnc it includad wieh�he discloud dam. <br /> The decemiinaaon of tha resporuible authoriry may be ap��led pursuaac w rhe pmvisions of du admSniaaarive precedure aet nladns to <br /> conresxd cases. . ' ' <br /> DAT�, pRYVACY ADVISOR'Y <br /> �n accordance wi�h M.S. 13.�4,Subd.2, "Rights of subjects of data"�we would like co inform you that yonr request <br /> for a permit or license from the Ciry of Oroao or any uf iu departmears may require you to furnisl� cercain priva�e or <br /> confidential information. <br /> You are notified that: <br /> 1, 'i'he informa[ion you fumish will be used to�iecermine yaur qualificatiou for the permic or license requeszed. <br /> 2, You may refuse to supply data, but refusal may require shat the Ciry deny the permic or licease. <br /> 3. The iaforniacion may be shared with other tocal,sta�e or federal agencies to the exteni necessary to process <br /> rhe permit or license. <br /> 4. If your requested permit or ticttasst requires Council action to approve, some informauon may become <br /> public. <br /> 5, you have cenain righ�s under M.S. 13.0� (available upon request) co review private da�a on yoursetf. <br /> 6, Your fuil aame is required co process thii spplicacion or peraiit. � <br /> F'uSc rliddle 1.85[ <br /> Address , <br /> ���, Snte Zip Pt►one . <br /> I understand my rights as s�aced above. <br /> Signaturc <br />