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09/15/2006 13:51 763-559-0148 ENPATH MEDICAL PAGE 04/06 SM13M RIGHTS OF SUBJECTS OF DATA Subd,1.Type of data The rights of individual on whom the data is stored or to be stored shall be as set lbrdr in this section. Subd,2.trdbmration required to be given individual.An individual asked to supply privW or conFdgmiml data concoming him clfshall be infnrrried of(a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,m statewide system:(b) whether he may refuse or is legally Tdquired to supply the tr quosscd dole;(c)ally/slower conacquence arising ttoro his supplying or refusing to supply private or contidendal dote:and(d)the identity of other persona or entitles audrarized by watt or federal law to receive she data This requirtnncrtt shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision S.to a law enforcement officer, ng commissio r of revenue M place thcLnodfil reguired Alec this s+r+ bi9lon in the Individual iagOrae tax or Willi U taxaml instructions instead of on dtmae IbrrnS. Subd,3.Access to data by individual,Upon request toarcaponsibleauthority,anindividualshallbeinfomiedwhetherheisthesubjector stored dam on individuals.and whether It is classified os public,private or confidential. Upon his f ether regacst,an individual who is the subjectef stored private or public data on individuals shall be shown the data without any cheeps to him and,if be desires,shall be informed of the content and meaning of that data. A fter an individual bas been shown the privets data and informed of its intoning.the data need not be disclosed whim ibr six months thereafter unrest a dispute or action pumuatU to this section is pending or additional data on the Individual has been collected or created.The resptmsible authority shall provide copies of the private or public data upon request by the individual subject ofthe data, The responsible authority rMy require the requesting person to pay the actual costs of mating,certifying.and compiling the copies. The rwponsible authorlty shall comply immediately,if possible,with any req»est made purn iam to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays.if immediate compliance is not possible.If he cannot comply with the request within that tinie,he shall so inform the individual.and may have an additional five days within which to comply with the request,excluding Sanudays, Sundays and legal holidays. Subd.4.Procedurawho data isnot accurateofcomplete.AnhWividualmayeontmdwaccwugorcomplctareesofpubliearprivandata concerning himself,To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement.The responsible authority shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify past rccipients of inaccurate or Incomplete dam including recipients named by tM individuaL.or(b)raify the individual that he believes the date*be correct Detain dispute shall be disclosed only if the individual's staaanent of disagmcirient is included with the disclosed data The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to comested cases, DATA PRIVACY ADVISORY In accordance with M.S.13.04,Subd.2,"Rights of subjects of data".we would llketo 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. You are notified that: 1. The information you furnish will be used to determine your qualification for the permit or license requested. 2. You may refuse tet supply data.but refusal may require that the City deny the permit or license. 3. The information may be shared with other local, state or federal agencies to the extent necessary to process the permit or HOOPS . 4. if your requested permit or license requires Council action to approve,some information may become public. 5. You have certain rights under M.S. 13.04(available upon request)to review private data on yourself. 6. Your full name is required to process this application or permit. Michael Daniel Novak First Middle [.est 3640 Togo Road Address Orono MN 55391 (952)906-0870 -ally state Zip Phone I oaderstand my rights as stated abuve, %A t5 r CKO Signature 32