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SmUM RiCUfg OF SUBJEM OF DATA <br /> Srtbd.1.Typo of data. The rlgbrs of tmdivldnal on Whom the data Is norod or to be stored abap ban met taro ht tbb swb L <br /> Sabel,2 IaforxOWan rogdn d to bo glM indlvidoal.Aa iudb fk u d adod is mpptr ppm or eonfldcntW data wa g htameNstratl be <br /> informed oft (a)the purpose acid tatmded use of the requmtcd dais wiWin the C0199a6 MO agency,poNde d sAbdivbbon,or stnevat gsteml(b) <br /> wbcdm be my minae orfs legatfy r pared to supply rhe rteptuad datig(e)spy k w n concapm ce artslcig fn=bin sapplybgor n&dug to mppr <br /> ply tadtvtdsal b asked m hofo pt motOtea to secaon 13A s�tbdtvidoa 5,to a eateorcemawt dam.dxtL � <br /> The eammtsslones of revogue mmv pia^m me motes neAybvd adder do sobdgvftn to the Iod(yidaal faeeme to or nenn�tv�,eyod <br /> tasgmedaaa tawead o[on those fart. <br /> Subd.L Amm os dms by ladviddaL Upon request to a rmpeosible anthoriq,an tatlivi"dIOR be Wormed wbdhcr bo Is the subject or <br /> sm vd data on hWVMPd%and whether It b e azWed as pmbgt;,private or comIIdit&L Upas bb farther Mpe%an bndividuat who b be snbJea of <br /> stored privste or public dam on indivWMb did be shown the dam wkbomtacy chargero klm amt,tr he detira.AO beInformted ofthe content and <br /> mesoittg ofd d cam. After to todhidual has beam drown the pddvatt data tad tntormed of iia the data no avt be dbxbW to hist ror dx <br /> months Woreerter unlen a dbipum or icilon pwawnr to"setsh,u it peadtag cr oddtdond data an the h dtddmd bas bem cWsmsa or[Tamed.The <br /> re*msftamhort sbxgPM kbocopksoftheprtvakcrpaMdaraapoa"quutbythebtd[dhalsub)eete«Qdam.le omeamthorByma. <br /> n4 dm the regoesttng person to pay the sap#)eosb of making,ss�'ytog.aadoempfflq the eapkW. <br /> Tlurdsponiiblotutborigrafialtcomptybmmedtateiy.ifPGuibl4wkb any repo+stm$deparmaatftthlssnbdbviabo,orwkblu bcdaysefoe <br /> daeordwreques<.ctcladiaffi ybsuadi'eand L*dhash[aM ffhaxpeamcnVommeftaotpoasible:Ithonanotoomplyvmearequtstwbbtn <br /> tbartlme,>scsbausptatorm rbehsdbvldmd,aadmay bsvesn addhktcitl Five dayswTabtnsvhkh toota�g9gttbereqaest,e�ludicigSattuaaps,�ds?s <br /> and legal hoiidays. <br /> Subd.4.Prnodstowluada Aknotaccmrmorcmyp <e,Anladtvklaaimnymnomaeaftumcyorceopl so[pvbpeorprivatedata <br /> eoseerningidttts Toe�teroisrttrbthr,an�dtvWaalsbaRaotii�rimwritin$�ares�nslblatathurltydsruatureo[Wedtsasreestent The <br /> TeWoudbit and oft shoR w#hbt 90 days ehtten (a)cm. On des foasd ro be hmemrate or bousptem nd attempt to aetlry pm rra3pft t of <br /> ioacemratcor loe mpleve dan,todudiog rodpleaq umed by ft lodividush m'(b)no*the hrdhi4o l tmtbebcSdves the dam to be eorrem Dara to <br /> AVM"be disdesed only irthe hadtvldnaVs amtement of dot b lodaded wab the inclosed data. <br /> The danwIM n of rhe respo attmorW may be appubd pursuant to the prortdaas of the administrative procedure met rd4ft m <br /> contested=WL <br /> PAU PRIVACY ADVXSQIt�C <br /> In accordance with MS.13-04,3ubd.2,"Rights of subjects of data",we would iike to inform you that your request <br /> for a permit or IIcenu from the City of Orono or any of its departments may require you to rarni9b certain private or <br /> coundential information. <br /> You are notified that: <br /> 1. The Information you fwmkh will be used to determine your quMeaeimt fortheperndt'or licenseregnested. <br /> 2. YOU may muse to supply data,bat rethsal tray require that the City deny the permit or Hmim <br /> 3. The information maybe shared with other kwal,state orfederal agendas tothe Utentnecessatytoproem <br /> dw permit or license. <br /> 4. If your requested permit or license requires Council action to approve,some information may become <br /> public. <br /> 5. You have certain rids under US.13.04(avallable upon request)to review private data an you sell <br /> 6. Your full name is required to process this application or permit. <br /> >i ddb tan <br /> Address <br /> 'may Stato Zip Mae <br /> I ondersftnd my rights as stag above. <br />