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Nov 27 06 12:OOp The Gopher Company 6123317725 p.2 <br /> Sw33A4 RIGHTB OF SIIBJIX.'CS OF DATA <br /> Subd.1. 'I�pe oFdeta. The righcs of individoal oa whom the dsta is sm¢�ar to be st«nd nhap be as aet fonh ia tfiis seccion. <br /> Subd.2.Eobmmetiaaiequi�edtabcBv�►individoe►.AnmdividoalaslrodmsuPP�S'P�vsteoraonfidmtieldetaca�ocrni�himselfshalibe <br /> info�ed at• (a)the paryose aod�tended use of the ir,questcd da�e withm the aaUa�ing sta�ageacY.Pditi�al subdivi�iam.orslatewide rysoc�(b) <br /> wbei]urLe may m�Lsa or is IeB�Y�9�d tn supply the reqnested dam;(o)aay kaowa caaseqoence eri�g 6om his suPPh'�8�T�B��P�Y <br /> �ivsla orconfrdmtial dete;and(d)the ida�tiry of oUxrpersaasorsatities�utho:ized by s�e a fedQal Lw w�eceiw th�data.This ceqaicement s�all <br /> na aPP1Y when ee wdividael is asked W suPP�Y�vestigative data,Pnrsuaat w section 13.82,sabdivi�oa 5,ta a law eafaaeaneat offiar. <br /> T'he oommisaiomr af�evenoe misr nlace Ihe natice roaared imder this sa6division in the itd�stal incoaee t�ar�pg(y tax refund <br /> 3astrnctiaa�9�stead of oa 9wse forma. <br /> Sl�b�3.M�eas lo data by mdividual.Upm roqne�t to a nspamoible�thoriry,an iodivichal s3uU be mtormodwl�hczhe is the sabjecs of <br /> swreddata�individusis,sad whetha it is classiGed ss poblic,�aivau ua�wm6dea�tial.Upim hia far4ta r�quest,en mdividual who ic the snbject of <br /> sto�edprivete or poblic data on i�dividvals a6all be sbowa the data wi4ouc aey charge m hiro end,if ho deaias,93aribe infora�e�of rhe ooatemand. <br /> rae�iag of that data. ABer en iadivi�al has bxn sbowa the private data snd iafoaned of iis mea:nng.�e dam nxd noe be diselosed W him!ac suc <br /> mo�Ws il�eRafter nafesa s disputc or aclioapesmnt Io this eation is pend'mg or additional dataon the oadividud hes been coiiatad or c[ested.7'Le <br /> �oosibk autha�iry shell pQwide copies of the privafe orpnblic data apa�ieqoest by the in�vidual su6ject of the da�.The nspo�'bk aut6orily <br /> �'io4urte the te4u�8 P�a w pay the ac0u]oo�ta otmalang�cartifyi�g,aad campiling the copies. <br /> T6e�apo�ible wthodtyshall camply immedieoely,ifpossible�WILb 9Dy 1EQt1CSL2BYdC pU1SGOnl i0(I115 S11�1V►SlOR1.d[NIUI�f1VC fld�Of <br /> 1Le dateofdx�qnesl,ezcludio8 SauudeYs�Sondsys rndkga(ho4dsys,ifimmedieoe�oopliauce is aotpossibb.Ifheceanol caua�ly witlittue mquest <br /> wil6in thas time,he sbell so infau•mtheiadividoal.�md msy have an additional five days within wktich m cmaply with tlie iegual,a�clnd'a�5enmleys� <br /> Sandays aad legslholidays- <br /> Subd.4.Procedmewhm data is na ecemte ar mmplete.Aa iadividuel mey ca��est the aaoncy o�completeness o#pn6lic orprivale data <br /> cunee�ning hjmsel£To Qaaiee this ri�t,aamdividual sLallnotiCy iawriung ffiosesponsibleaat6atirydescn'biag tLensaveofthe dise�e The <br /> issponsibk authairy sha11 within 30 days eitber: (a)eorrecc tbe data fouad W be inaccu�su ar iocao�lete�d atoe�opt w nodCy psst iecipieam of <br /> inaecwate�uxamplete data,iaelading recipimes nexned by tha�dividual:or(b}notil�+tha ipdivfdual d�et he bdieves ihe da�m 6e aa�ecc Dam io <br /> dispnte shall be discbsed only if tix iadividael's staumeat of disag:eemeot is incladed wi�L the diaclosed drta. <br /> T6e delenniaetion ofthe mpo¢uble authoritymay be appealedpmsnmt w the p�ovisions of f�e sdmuniitrative proce�ae act rcAeoog m <br /> eo4roestod cases. <br /> nwTA rtuvacY nnv[$ORY <br /> In aecordattce with F1+f.S.13.04,Subd.2,"Rigtrts ofsubjects ofdata",we would like ta inform you that yousrequcst <br /> for a permit or license from the City of Orona or any of its depmrtmeats may require you to fimsish cectain private or <br /> coQfidential iaformadon. <br /> You are rwtified that <br /> !. The infoimatian you fumish will be used tfl determine your quali�fication for the pernut or license <br /> ��• <br /> Z. You may refusc to suPP�Y�,but refiisal may roquire that tbe City deny the pe�mit or(icense. <br /> 3. The infom�ation may be sbared with other locxl, state or federat agencies ta tfie ex6ent necessary to <br /> process the permit or license. <br /> 4. if your reyuested permit or licens�e requires Couucil action to approvc,some inforrnatian tnay become <br /> public. <br /> 5. You have cerhsin rigt�s under M.S. 13.04(avaa'lable upon request)to review private data on yairself. <br /> 6. Your fi�Il na.me is reqvired to pr this application ot pemrit <br /> ' �.. - �� ��- � � <br /> F:r.r �aaak , t.�� <br /> �_ � ��' �u�i,�1U,Z - `JOv1,�1 <br /> aua�. <br /> �i�1�,L�a1 is `I�'1,1� 5��(�l-� ���z133►. ►S�5 <br /> �� <br /> c�cy smc� z� r�o� <br /> I underetaod my rigbta as Btated ve. <br /> � <br /> 91g�reure <br /> Reeet Fotm 32 <br />