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Jun-25-2001 01:52pm From-CITY OF ORONO +9522494616 T-298 P.002/002 F-611 Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. I. Type of data. The rights of individual on whom the data is scared or to be stored shall be as set forth in this section. Subd.2. Information required to be given individual. An individual ask d to supply private or confidential data concecming himself shall be informed of: (a)the purpose and intended use of the requested dart within the collecting state agency,political subdivision,or statewide system; (b)whether he may refuse or is legally required to supply the requested dais:(c)any known consequence arising from his supplying or refusing to supply private or confidential 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 az individual is asi:ed to supply investigative data,pursuit to section 13.82,subdivision 5,to a,law enforcement officer. The cotnrnissioner of revenue may .lace the notice r_ouired under this rubdivisio in the individual ' come tax o •ro.erty tax refund instructions instead of on those�orms. Subd-3. access to data by individual. Upon request to a res onsible 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 public data on individuals shall be shown the data without any charge to him arid.if he desires,shall be informed of the content and meaning of that data. After an individual has been shown the private data and ir.:orrned of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this section is reading or additional data on the individual has been collected or created_ The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require die requesting person to pay the actual costs of making.cecfying,and compiling the copies. The rc.sponsibie authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the dam of the re4uest,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,ke shall so inform the individual,and may have an additional Five days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd,4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private dam concerning himself. To exercise this right,an individual shall notify is writing the responsible authority describing the nature of the disagreement. The responsible authority shall within 30 days either: (a)correct the data found to be 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 to disclosed only if the individual's statement of disagree tent is 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. DATA PRrVACY 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 or confidential information. • You are notified that: 1. The information you furnish will be used to determine your qualification gualhe City dorn the ep ppermit or license it license.seruested . 2. You may refuse to supply data, but refusal may require • 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 ori yourself. 6. Your full name is required to process this application or permit. }416h4.4-el_— Ahverh4 •6-5 r&e2-- FirstMiddle Last1�a1 el"' 1.4/06- ll."orelieast Addre /ew A / ?37 -,S2.54 City State Zip Phone I understand my rights as stated above. t.A L = Signature