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AUG-03-2006(THU) 15: 25 P. 002/005 SM13.04 RIGMS OF SUBJECTS OF DATA Subd.1. Type of dam. The rights of individual on whom the data is stored or to be stored shall be as sot forth in this section. Subd.2.intbnmdon required to be given Individual.An individual asked to supply private orcontidential dam concerning himselfshull be informed oll (a)mite purpose and intended use of the requested data within the collecting state agency,political subdivision.orsmtewida system;(b) whether he may refuse or is legally required to supply the requested dam;(c)any known consequence arising from his supplying or refusing to supply private orconfidential data;and(d)the iderr W of otherpawns orenthies authorized by state or federal law to receive the dam.This requirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision S,to a law enforcement ofd icer. The commissioner or revrnue may place the notice ptipnlag Under this subdivisionAn-the indiAd hal income tax M prmiorty thx,r„gfynd instutions instead of on those lbm,s. Subd.3.Ace=to dam by individual.Upon n questto a responsible authority,an indivlduul shall be informed whether he is the suWcct of stored data on individuals,and whether it Is classified as public,private"confidential.Upon his further request an individual who is ihesuttjttct of stored private or public data on Individuals AM be shown Lite data without any charge to him and,Who desires,shall be informed of the content and meaning of that dam. After an Individual has been shown the private dam and informed of its meaning,rite data meed not be disclosed to him for six months thereafter union a dispute or action pursuant to this section is pending or udditionat data on the individual has been collected or created.The responsible authority shall provide copies of Uta private or public data upon request by the individual subject ofthc data.The responsible authority may require the requesting person to pay the actual costa ofmaking,cardfying,and compiling the copies. The responsible authority shall comply immediately.If possible,with any requetmnde pursuant to this subdivision,or within Ove days of die date ufthe request,occluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible.Ifhe cannot comply with the request within that time,be shall so Inform the individual,and may have an additional Ove days within which to comply with the request,excluding Saturdays. Sundays and legal holidays. Subd.4.Procedure when data isnotaccwatc or complete.An individual my contest the accuracy orcompleteness ofpublic orprivatedam concerning himself.To wwreise thisright,an individual shall notify in writing the responsible authoritydescribing the natureofthe dincreament.Ilia responsiblo authority shall within 30 days either: (a)comet thio data found to be inaccurate or Incomplete and anempt to notify past recipients of inaccurate or incomplete darn,including recipients named by the individual;or(b)notify die individual that he believes the damto be correct Detain dispute shall be disclosed only if the individual's statement of disagremnont is included with the disclosed date. The doswininatlon of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to contested caws. DATA PRIVACY ADVISORY 1n 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 inforniWon. You are notified that: I. The information you furnish will be used to determine your qualification for the permit or license requested. 2. You may refuse to supply data,but refusal may require that the City deny the permit or license. 3. The information may be shared with tither local,state or federal agencies to the extent necessary to process the permit or license. 4. if your requested permit or license requires Council action to approve,some information may become public. S. 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. -- oQ RAS - rvuYg First Middle _ Last � 20 Ta1eaVRt.1 l.oal� . Address a VIPW sac 4 ?VZ.47Z.003 Clry State 'Lip Phone I understand ghXnovc. 2 Signature oil, F9n 11TII til; ilhblld�al I SP It w pit.�,�I,lil��iu➢�I :f I lit 32