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May 11 06 10: 35a Katie Runstrom 7637831811 p. 2 Scc.13.04 RIGHTS OF SUBJECTS 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 section. Subd.2.Informationraquiredtobegivenindividual.AnindividualaskedtosupplyprivateorconfidentialdataconceminghimselEshallbe infortned of (a)the purpose and inoended use of thc rcquested data within the collecting st'ntc agency,politicat subdivision,or statcwide systcm;(b) whed►er he may refuse or is lcgally requirud to supply the requcs[ed data;(c)any known consequence arising from his supplying or refusing to supply private ar�delrGal data;and(d)thc iderrtity of onc�r persons or errtities authorized by state or federal law to rcx.eive�he datl This rcquiremerrt sha11 not apply when an individua!is asked to supply investigativc data,p�usuant to scction 13.82,subdivision S,to a law enforcement o�cer. The commissioner of revenue mav alace the notice required under this subdivision in the individual income tax or nroaettv tax refund instrvctions instead of on thase fom�.c. 5ubd.3. Accesstodaffibyindividual. Uponrequesttoaresponsibleauthority,anindividualshallbeinformedwhetherheisthesubjectof storc�d dara on individuaLs,and whether it is classified as public,private or confideniial. Upon his fucther request,an individual who is ihe subject of srored privute or public dafa on individuals shali be shown the data without arry charge to him and,if hc desires,sha!I be inEormed of the content and meaning of tha[data After an individual has beat shawn the privatc dnra and infomicd of its meaning thc data need nat be discloszd to him for six months thercafter unless a dispute or action pursuant to this secrion is pending or additional daha on thc individual has bcen collettcd or crcated. 'i'he responsible authoriry shall provide rnpies ofthe private or public data upon roqucst by the individual subjec[of the data. The responsiblc suthority may require the requesting person to pay the aetua!costs of making,certifying,and compiling the copies. The responsible authoriry shall comply imrnediat�ly,if possible,with any nquesc made pursuant[o[his subdivision,or within five days of the dabe ofthe request,excluding Satutdays,Sundays and legal holidays,if immediate compliance is not possible.Ifhe cannottomply with the request within that time,he shall so infonn the individusl,and may have an additional 1 ive days within which to comply with tha request,excluding Savudays, Sundays and le�al holidays. Subd.4.Procedure when data is not accurace or complete. M individua]may contestthe accuracy orcompleteness ofpublic or private data c:onceming himtielf.To exercise this right,an individual shall notify in writing the responsiblc authority describing the nature oftpe disagreetnent The responsible suthoriiy shall within 30 days either. (a)cortect the data found w be inaccurate or incompJete and attempt to notify past recipients of inaccwatc or incomplctc dala,including raipicnts namcd by thc individuel;or(b)notiCy Ihc individual that hc belicves thc dala ro be cormct I3ata in dispute shall be disclosed o�ly if the individual's siatement of disagreement is included witti the disclosed data. The dctermination ofthc responsiblc authoriry may bc appealed pursuant to the provisions of the administrative pracedure act rclaung to corttestc�d cases. DATA PRIVACY ADVISORY In accordance with M.5.13.04,Subd.2,"Rights of subjects ofi data",we would like to inform you that your n�qucst for a pennit or license from the City of Orono or any of its departments may require you to fumish certain private or confrdeniial information. You are noti f ed that: l. The infbrmation you futnish wilI 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 federaJ agencies to the cxtent necessary to process the permit or liccnse. 4. If your requested pem►it or license requi�es Council action to approve,some information may become public_ 5. You have certain righks under M.S. 13.U4(avarlable upon request)to review private data on youis f. 6. ur full name is requ' to process lhis application or permit. � ;C( ��1� �. ��-S First D�� Middk La.ct �/�!� /� ��ti Y. naa.� ��/�2G��, y�ti ��o��/ �l� 3-7P� �-�l2/ CrtY State 7.ip P6one I understand my rig�ts as stated above. � �vn � � � s�gnamre Reset Form 32