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From:ELDER JONES INC 952 854 4909 05/17/2007 14: 11 11253 P.003/003 a• • Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd.1. Typo of data• The rights of individual on whom the data is stored or to be stored shall be as sot forth in this section. Subd:2.Information required to be given individual.An individual asked to supply private or confidential data concerning himself shall bo informed o£ (a)the purpose and intended use of the requested data within the collecting state agency.political subdivision.Of statewide system_(b) whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying orrefusing to supply private or poufdenial data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data.This requirement shall not apply When an individual is aslcea to supply investigative data,pursuant to section 13.82,subdivision 9,to a law enforcement officer. The commissioner of revenue may Dine the notice require finder this subdfvislon in the individual income tax oryroperly tax nafuna ipchn.c.inns:ctfa4 of on thew,fhrm¢, • Subd.3.Access to data by individual. Upon request to a responsible authority,an individual shall be informed whetherhe is the aubjet of stored data on individuals,and whether it is classified as public,private or confidential.Upon his further request,an individual who is the subject of stored private or public data on individuals shell be shown the data without any charge to him and,if he desires,shall be informed of the content and meaning oitnat data. After an individual has been shown the private data and informed or Its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant tp this'creation is pending or additional data on the individual has been collected or created.The responsible authority shall provide copies ortre private or public data upon request by the individual subject of the data• The responsible authority may require the requesting person to pay the actual costa of making,certifying,and compiling the copies. The responsible authority snail comply Immediately,9fpoasible,with any request made pursuant to this subdivision,or within five clays or rho 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 time.he shall so inform the individual,and may have an addluonal nve days within waichto comply with the request excluding Saturdays, Sundayo and legal holidays. Subd.4, Procedure when data io not aocuraro or complete.An individual may contest the accuracy or completeness ofpublic or private data concerning himself. To exercise this right an individual shall notify in wilting the responsible authority describing Me nature ortne disagreement The responsible,authority shall within 30 days either: (a)correct the data found,tp irdd inaccurate or Incomplete and attempt to notify past recipients of inaccurate or incomplete data.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 atetotnent of dioagroom ent io 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 contested cases. AATA,PRIVACY AAVXSORY • 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 or confidential information. 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 other local, state or federal agencies to the exteait 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. -TTrl S&htn k First Middle lest /rat E Guth Sir A,ddcoa gl o6i7 /n Vi''`i' P)A ‘5sLIa City State Zlp phone • T understand my rights as st to above. Signature - - 32