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' Ju 1. 15. 2008 4; 06PM No. 2631 P. 3 Sec.".04 RIMS OF SUBMM OF DATA Subd.1. Type of data The rights of individual an whom the data is stored or to be stared shall be as set forth in this section. Subd.2.Information requitrdto be given individual.An individual asked to supply prince or confidential data concerning binpself be informed of: (a)the purpose and intended use of the requested data within the coUcc ft state agency,political subdivision,or statewide sy (b) whether be may rdvse or is legally required to supply the requested data;(c)any]mown consequence arising from his supplying or refusing to s y private or confidential data;and(d)the identity of other psora ar entities authorized by state or federal law to receive dna clue,This shall not apply-ben an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. The er of revenue ma place the notiae_renuired under this subdivision in the individual income tax or property tax refund inatog ions instead of on those forms; Subd.3.Access to data by individual.Upon requestto a responsible authority,an individual shall be informed whether he is the subjectof stored data on individuals,and whether it is classified as public,private or confidential.Upon his ftatttet request,an individual who is the subject of stored ptivate or public data on individuals shall be shown the data without any charge to him anti,if he desires,shall be informed of the content and meaning of that data After an individual has been shown the private data and informed of its meaning.the data need not be disclosed to him fdr six months thereafter unless a dispute or action pa suaw to this section is pending or additional data on the individual has been collected or created.I The responsible authority shall provide copies of the private or public data upon request by the individual subject of the dam. The responsible authority may require the requesting person to pay the au;atal costs of malting,certifying,and compiling the copies. The cesporuible authority shall comply itmndiately,if possible,with any request made pursuattto this subdivision,or withinfive days of the date of the requtest,eitohading Satrdays,Sundays and legal holidays,if immediate co wliaoce is not po5 4g&Bhe Cannot comply with tine request witbuu that time,he shall so inform the individual,and may have an additional five days within which to oompbr with the request,Wuding Saturdays, Sundays and legal holidays. Subd.4.Procedure when data is n0tacct=or complete.All individual may contest the accuracy or completepeas ofpublic orptivan data conedmiag himself.To exerdce this tight,aq individual shall notify in writingthe nspoosible autboriry desttibIDgthe tnsaae of the dtsttgreement The responsible authority shall within 30 days either: (a)context the data found to be inaccurate or Incomplete and attempt to notify past recip"of maccurme or incomplete data,including recipiems namad by the individual;or(b)notify the individual thatbe believes the danto be correct,NO m dispute shall be disclosed only if the kAvidual's statement of disagreernatt is irxlt►ded wbb the disclosed data The detemupdop of the responsible authority nay be appealed pursuant to the provisions of die administrative procedure act relaI64 to conarswd 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 Of confidential information. You are notified that: 1. The information you furnish will be used to determine your qualification for the permit or licensers 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 other 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. 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. Sam Lynn VanVickle — a FM Mddle Last 1743 County Road F Em Address V4M]BEAR LAKE 55110 (612)623-1982 sty state Zip ]Phone I understand rights as stated bove. Signature 32