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FF'Ci�l : T i rnl;er-1.1.r-�r{ B�_i i 1�{rT_"� F'HnhdE h•J0. : r 1� '�+4'� GZ�I��'� _T,9.r�. G1^ �l='1l='1l='1 11:��H�`� F'1
<br /> Scc.13.U4 RIG�iTS OF 5E)B3iF,CTS OF DATA
<br /> Subci. 1. 7'y]?�of data. 'C'hc rights oF inc3ivii1u11 otl whom thc data is s[ot'ed or tn t�c sioreil s(1<tll be 35 ScE f�otth in Chis scCtiUtt.
<br /> SuLki.2. 7nformntim�required to be givea iadir^idui�t. Ata individual askrd to supply private or cunficlen�i��l d�1t;t cpncerning himself
<br /> gh;111 1x infomxd of: (al thC pur�?Se a�td in[srxicd use af the reque�t�Cl d�iSz�L'�th�n thc co!►eCeing SL'+te a�cncy,�wfitical subilivisiun, ot�statcwide
<br /> �ysccm;(b)whcdter he may reliisc or is EegaUy rec�uired tn supply thc rcquZsted data;Ic)srcl kno�vn consequcr,cc arising from}ais sup�lying or
<br /> refusing to supply priv<u�Ur�o�ilenti:tl clai:e;xn�!fd)thc icleniiry of o�er�+erSotis or e»tiriec authnrized by state ar faderal 1aw fa receive the data.
<br /> This requiremer��shall r7oc sppiy whari a� individ�a! is as}:ed to:upply t[lva5flg7f7�'C[1.�ta, �?ur.Cu�nt t0 Se�fiO» ]3.82, culu9ivissen 5, ta a]aw
<br /> eniarczmen[afficcr,
<br /> �5 S�.nmm�.;�;nner nf revenue mav nlacc thc pptic.r.rnr1�ircd uniler this.s»kxiivision in thr.Jndiviilu�l incnme [.3x nr nrooem t,3!c refund
<br /> instru�tiu�s ip�tead of'nn thoac fnrms.
<br /> $ub3. 3. Access to datst hy i.Gdi+idu01. i1��n requcst[o a respons'tble tictdio�iry, �n individual shdll be itifGCmed whet37eY he is the
<br /> subject of scvred data nn individuals, and whathcr it is elus3iFied a..pul�lic, �revate.or confidential. IJ}�nn his h[Rher icyuext, en in[{ivi�u31 WE10
<br /> is nc�subjcct of srorcd�ri�,yte c�r puh3ic data 47n indi�iduals sh311�ShO�L'11 Ih2 d0r.a tt'i[hout any C•}I�CgB f0 1)x111�n�l, if he de�ireE, Shai!hc infcimted
<br /> af the e4nsextt and mcaning of that d;ita, After��n itt�ividua] ha�hecn shown the�+rivate��c3 and infrirmed af it��t:eaning, die data need not bc
<br /> disclo5cd to him for se.�mUnth3 t}zereafter unless a disputo or aCtion puCs'U�ttt t0 thic secban i5 E�ndS7tg nr additinn:tl dat3 nn thc individu3l h3s been
<br /> collecced or crcaeed, '�7�c res�inn.sible auttiority sh��31 proYida capia,of�hc privace or public data u�n rryuest by d�e uidivid��a] suhject nf the data.
<br /> 'T'hc respUnsil3�e�au�hnrtry m3y reyuire tfte reqteesfins��rson tu pay the 3CtU1l COcrg nt making, �eriitying, and cunZp9ling che copins.
<br /> Thc resporuihle authoCi�}�Shall ccmply immedi:�tely, tf posSible,with any ree��est naade�,ursudn[tv 13yi5 SutxllviSioll, oc withtII .fivt day�
<br /> nf the date of the teque5t, cxcludin�Saturdays,Sut�d�4ys and le.g.a!holid3yS,if itnmediatc nompliancp is noc p�ssihlr. If hn c3nnut COtttply'wlth
<br /> the requeft within that time, Ne shall gb fnfo!ni tho indivtdt111, anci may have sn�ildirional ftve days wiihif�tvhich tn contply uiih thc rryurst,
<br /> cxcluding Saturdays. 5tttldays and legsl hali�ays.
<br /> $ubd.4. �roccdurc vs'hen data ic nnt accurate or cumplete. AR individual m�y COIItzsi thc accuracy or Cumpleteriess af publfC oi
<br /> Private daCt conceming Et�iTisclf. To exerci>e ticis riKht,�irt iqdividual shall noCify ln wTiting the responslble nllthniity deSctihing the nature Of�tle
<br /> disagcCcmenc. ',�1c responsibla authority ch��lk witi�in 30 day=cithr.r: (�)cozrect the dard found Iu be inaccurate or inCurrfple.te and aetemp[to notif�'
<br /> p�LST t'cCipi�nt5 nf in:icuur<tie or vlconiptc2c dara, inctuding r�cipienis namcd by tht ifldl�idual; nr(Ei} �io[tty the IAdividusl that he helirvns�he data
<br /> t��be corrcct, I?tiff in dispute shall bc disc143ed unly if thc.individaal's Sk'itemant af disaStezal�en[is ir.cludcd with Chz diSClOSed dRta.
<br /> 'z7�c dcccm�in:�tian of[he resF?oRsihlc authority n�<iy 1�e�3ppealed pursuan�to the prnv�sior�s nf the adn?inic�racivc�,roccdurc act relating
<br /> ro co;�tesicd cases.
<br /> D.AT:� PRIVACI'_�,,�Y?SORY
<br /> X.r� accordance with M.S. 13.04, Subd, 2, "'Ri�hts of sut?jects of data", we would �ike to inform you that your
<br /> raquest far a permit or license from the �ity �f Qrqno or any of its departmetlts may requiri;yozi to fiiraish certain
<br /> Qrivate qr con�iclentiai uiformation.
<br /> You are nQti�ed that:
<br /> J. The i.�torniation you furttish will be used to determille your qu3litic3tiot� Xor the permit or licensc
<br /> rec�uested.
<br /> 2. "You may ri:fuse ta sup�ly dara, but refusal may require tha� the City deny the permit or license.
<br /> 3. Tl1e 1�formati�n m�y l�e sbared with othe�' locaI, state or federa! agencies tc thc extent necessary to
<br /> procass zhe permit or license.
<br /> 4. ff yaur rcqur,steci�rt�lit�r liccnse rcqu�xes Couricil 3ctinn to �pprnve, some information r��ay hecome
<br /> ptiblic.
<br /> 5. You have certain ri�lzts under M.S. 13.04(av:iilable upon rec�uest) to review pPivate data on yourself.
<br /> 6, Yaur full name is required to proc ., t.hit applic.ation or perinit.
<br /> 1 �
<br /> First \!i dle Lasc
<br /> I-J�
<br /> Addres� .� ["'V�P!�
<br /> J
<br /> C��.S, Statc 2ip Ph4nc
<br /> I understand r' [s as �tated �ive.
<br /> SignaRlre --_.. � � . .
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