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CITY OF ORONO � 6124730510 11l20/97 12:36 [� :03/03 N0:881 . � Sec.13.04 RIGHTS OF SLJB,IECTS OF DATA Subd. 1. Type ot data. 3'he righu of individual on whom the data is stored or to be stored shall be as ut forth in this section. Subd.2. Intotmation required to be�rea lndlvidual. M individual asked to supply private or confidential data concerning himself shall be informed of: (a)the purpose ud'uuerded use of the requesud data within the collecting state ageney,political subdivision,or ststewidc system;(b)whether he a�y refuse or it le�ally requised w svpply the requested data:(c)any known consequence arising from his supplying or refusing to supply private or confidenti�l dau;and(d}the idendry of other persons or enpties authorizcd by state or federzt law to receive the data. This rEquirement shali not app►y when an individual is asked to supply invesdgative data, pursuant to secaon 13.82, subdivision S. to a law tnforcament officer. T►,�r�,,,micc�onsr of revenue vL?v olace Che notice rea�ire�under�hie«bdivision in�he individual income Lx or orocerN tnx te_f�nd instrucdons instead of on those forms. Subd. 3. Accesa to deta by tndividuai. Upon request to a responsible autfiority, an individual shall be informed whether he is the aubject of arored dara on individuats,a�d whether it is classified as public,privam or confidential. Upon his further rcquest,an individual who is the aubjecs of stored private or public da�on individuals shall be shown the data without any charge to him and,if he desires, shall be informed of the content and meaning of thut dati. ARrr an individual has been shown the private data and informed of its meaning,the data need not be disclosed tn him far siz rtwnths thtceatocr uniess a dispute or acaon pursuu►t Oo this secaon is pending or addi�ional.deta on the individua)has been collxmd or creatod. 'ilx roaponsible authoriry shall providc coQics of the priva0e or public data upon request by thc individual subject of the data. '17ie responsible authority may requir:tha requesting person ta pay the actual costs of making,cerrifying,and compiling the copies. The responsible authority shail comply immediately,if possibie,with any request made pursuara to this subdivision,or wi[hin five days of the date oE the request,ezcluding Samrdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the eequest wirhin thae time,he shall so inform the individual,end may have an addibonal five days within which to comply with the request, excluding Saturdays,Sundays aod legaJ halidays. S�bd.4. Procedure when data is not accurate or complete. M individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this righe,an individual shall notify in writing ths responsible authoriry describing the nature uf the disagreement. The responsible authonry shall within 30 day9 either: (a)correct the dara found to be inaccucau or incompiete and atumpt ro notify past recipienLs of inaccurate or incomF•lete data,including recipients named by the individual;or(b)notify the i�ividual that h�believes the data to be corrcet. Dau in dispute shall be d'uciosed only if the individual's statement of Qisagreement is included with the disclosed data. The determination of the responsible suthority may be appealed pursuam to the provisions of the administrative proceduro act relapng to contested cases. DATA PRIVACY ADVISORY In accordance with M.S 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that your request for a permit or license from the City of Orono or any of its departments may require you to furnish certain private or confidential information. Yon are notified that: 1. The information you furnish will be used to determine your qualification for the permit or license requested. 2. You may refus�to supply data, but refusal may require that the Ciry deny the pernut or license. 3. The informat'1on may be shared with other local, state or federal agencies to the extent necessary to process the permit or license. 4. If your requeste3 permit or license requires Council action to approve, some information may become public� 5. You have certain rig3its under M.S. 13.04 (available upon request)to review private data on yourself. 6. Your full name is required to process this applicaiion or permit. k G L�N �L,L�,V' �S'��c=R,S First � Middle Lasc X j��'G /'/GNc_�7L C2c-ZTK CC=Nr'�T'� Address x �I�-t�t� �'��v /�"Iti� �s—sj�s`y ��% ��i � c�ri r-- s�u z►� Pnone I uaderstand my rights as stated above. �C � � - C��,Gl�� signaaere ' 6