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Oct-18-2000 04:071pm 2rx-CI7Y OF ORONO +9522494619 T-824 ?.0031003 F-338 sec.l3.o4 iuGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored si;all be as sat forth:r chis steam. Subd._. Y enation required to be given individual. An individual asked to supply private or confdeotial data concerning himself shall be informed of: (a)the purpose and intruded use of the req:iesud data within the aolierting ALIG 430ney,political subdivision,or stawwide systdm; ib)whether he may refuse or is legally required w supply die requested dare;(c)any known,consequence edetic froth his st:pplying or refining to SUPPLY private or wiif~dcntiai data;and(d)the iderrtity of ether persons grentities aurhorkred by state or federal liw eW receive rhe data. This requirttmem shall no:apply when an individual is asked w supply investigative dam,pur3uaat to section 13,82,subdivision 5,to a law enforcement offtor. The commissioner of revenue maw elate the nonce reduiree undV dtlr u ijYlsion in rho individual income tax d'nr'7Aorn>rK.ref7'.trd jngruprions irmad of Qtr those_fom, Subd.3. Aceese to data by individual, Upon request m a respoltsible awliotity,as individual:lull be informed whether he is the subject of stored darn on individuals,uxl wh=cher it is classified as public,private or confidential. Upon his ft:sthcr request,an individual vhf is rhe subject of swted privam or public dare on individuais shall be shown the darn without any charge to him and,'if he desires,shall be iafermed of dm eohteat and rtuaning of mac darn, Atter an i:rdividuil has beta zaawn the private data and infer-cod of its meaair:g,the dau teed nor be disclosed:c him for six moadu dwfaafwr urdess a dispute or action pursuant to this section is pending or adidonai dace on the individual has been collected or created. The responsible authority fta provide copies of the privan or public dam upon request by the individual subject of the dare. She responsible aatbOrity may requite the requesting,pdraft m pay the actual costs of making,terrifying:And oomplllrig the copies, The r_sponsible authority shall comp:y u=wdiately,if possible, with arty request made pursuant to this mbdivislon,or within five days of the dais of tie Mquast.excluaLu Saturdays.Sundays and legal holidays.if immediate compliance is not possible. Y.°ire earrnae comply with otic requecr within that thee,ho Shall so inform Is individual,and may have an additional five days within which to comply wish the request,excluding Saturdays. Sundays and legal holidays, Subd.4 Proeedure whey data is not accurate or compiste. An iadividual may contest:du accuracy or completon--ss of public or private data concerning himself. To exercise oris right,wi indivtdcal shall notify is wrting the responsible audroriry describing the nature of the dimome erit- The responsible authority slid';within 30 days either: (a)correct the data found to be uraccutau-or iocomolere and artarnpt to notify past mcipirnts of inaccurate or incomplete dau,iaeluaag recipients named by tha individual:or(b)notify the individual rhe:he believes dre dam n be correct, Ante in dispute shall be discloses only if the L-4vidual's smtetturtr of disagreement is included with the disclosed data. The dctent.nadon of int responsible audwriry may be appealed pursuant to the provisions of the adminisizative procedure:ret relating in contested cases. I)AIA PRIVACY AMISURY 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 er license from the City of Orono or any of ars depM31nen.t5 may require you to f'.irnis31 certain private or confidential information. You are notified dal: 1. The information you furnish will be used to determine your qualification for the perncit or licewd requested. 2 You may refuse to supply data, but-efusal .may require that the Cir/ deny the permit or license. The 'information may be shared with other local, state or federal agencies to the extent aecessaay To process ilio permi, or license. 4. If your requested permit tar license requires Council action to approve, so= information may become public. 5. You have certain rights under KS. 13.04 (available upon request) to review private data oat yourself. 5. Your full name is reVired to process this applica?ion or permit. First Middle Last Address P C1 C fir i/ Cary State Zip 3?hfnr I undersLand my rights "a:ed above. a re t/