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CITY OF ORONO 6122494616 11/01/99 16:05 [5 :08/10 NO:584 Sec.13.04 RIGHIS OF SlUBJE(_"TS 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 forth in this iteetion. Subd-2. Information required to be given Indavidual. An individual asked to supply private or confidential data concerning himself shall be informed of: (a)aha purpose and intended use of the requested data within die collecting state agency, political subdivision, or statewide system;(b)whether he may refuse or is legally required to supply the requested data; (c)any known consequence arising from his supplying or refustng m supply private or confidential dais;and(d)the identity of other persons or enrides authorized by state or federal law to receive die data. Thin requirement shall not,apply when art Wlvidual is asked to supply investigative data, pursuant u) section 13.82, subdivision 5, to a law enforcement officer. The comraiuionar of revenue may nlacr the notice..mired under this subdivision in the individual i ti time la,�_p��pem Lqb In. uctipns astead f on a famu. Subd, 3. Access to date by individual. Upon request to it responsible authority, an individual shall be informed whether he is the subject of stored data on Individuals, and whether it is classified as public,private or confidential. Upon his further request,an individual who is die subject of stored private or psuhlk.data on Individual.&shall be shown the data without any charge to him and, if he desires,shall he informed Of the content and meaning of that dam. After an individual has been shown the private data and informed of its meaning, the data need not be disclosed to him for six months thereafter utnlem a dispute or action pursuant to this section is pending or additional data on the individual has been colleted or created. "Ria responsible authority shall provide copies of the private or public data upon request by the Wlvidual subject of the data. The responsible authority may require the requesting person to Pay the actual costs of making,ecrtifying.and compiling die copies, The maponsible authority shall comply immediately,if possible,with airy request made pursuant to this subdivision,or within five days of the data of the request,excluding Saturdays. Sundays anal legal htilidays, if immediate compliance is not possible, If he cannot comply with the request within that time, he shall so inform the individual, and may have an additional five days within which to comply with the request. excluding Saturdays, Sundays std legal holidays. Subd.4. Procedure when data Is not accurate or complete. An individual inay contest the Accuracy or completcnese of public or private data concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the dhragroatnent. The responsible authority shalt within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify PW recipients of inaccurate or Incomplete dam, including recipients named by the individual;or(b)notify the Individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement Is included with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of rite administrative procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S, 13.04, Subd. 2, "Rights of subjects of data", we would Iike 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. 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 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 fill name is required to process this application or permit. First Middle Last 193 0 P?, ;/e. KI, Address y -- -- - wot t/ a l_/a City State LD Phone I understand my rights as statediabove. 9lgnature --.--. 6