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AuR-2�-2�v0 09�09am �ram-CfTY OF ORQNO +g522494616 T-464 P.Q481D05 F-07d � � scc.�s.oa�uGxz:�aF sF.�c'rs o�n.�'r�, Suhd. !. 'Y'ype uP data. The righzs af iadiv4dtial nn wham the data is smc�ed or�o be stored shall i�as sec fQr�in rhig grc�i4Q. Subd.2. Infocmation rcc}uired to be giveu individirai. An individual askrd ta 3upply FinatG or confidcnrial ran coaccruiu�7i�us¢1f sha.li bc infotmcd oi; (a}rhe purpose and inrended use of�he reqeeesud da�a withi,u the coIleoeag 8tatz agancy,pati�ca7 subdtvision,or srarawide sysreut; {b)whechtr h�may reEi�se or is Iaga.tty rcquirad ta suppiy�hc raGuesse�da�;(c}su�y hnbwn cuva�}utnce arisinb frouz.us s.eppiying or rrfusing m suAA�Y pti�$tb or 4ont'vi�ocsl dsts;and{d)thc idenriry of otiter�crsons or snti4�3 authqr3�ed by srare or federal Faw m tecenve thc¢�te, 't'�,is ze�uiacmrnt shall noc apQ!y w8an an et�3iy�dua3 is aske�ca supdiy ir:vesrigaavt dara,pursuant co sccdon i3_82,subc�avisiaa 5,so a Eaw enforcement officer. • 'tT!�_commissionsr of rcYsauo mav place sho nG�s� requim3 nnder ehis �i�division in rhe individuai �naoma eax dr pron�mmr tsx refund tnsttuCtion9 i�'stcsd of dn tho:e for.n.s. 5uhd.3. Aceess ta data by fndividual. L`pon raqvcsc tn a rosponsibta;�uthori:y,�n indiviciusi shxlf be inPormed whether he is tha subjecc aP stared dara an irtdivi�u�is,u�i wh��her tt is ciassiried ss putrfic, privsre or caaf.•dzneial. Jpon his furrhsr zequesc,an iadividua:wha is the suhjace oF srnred prsvatc nr puhl9c data o�i�iv�dusls shali tx shown Wc ds�withattt as�y chacgC co hisa ai;d;if hn d�sizns. shall bc itsiormed of[hC Coa�cat and meaniug of chat da�t. Afur an individuai has beer.showTi thc pnvatc data and inPamscd nf its mtsping,L7t d3L3[iCCd 60L bC diSCic78td IO h1217 f0! six monchs thereafter¢nless a disguu ot acuoa putsuant ta this s�b�ri�s pett�itng�Sr sdctidonsi daca an the iadiviauat pa9 bcen colttetcci or creattd. Thc res�orsi5te au�ority shail srovidc aopi�s of the�n+rarr.e+r Puh:M dsta upen raqlies�by che individua!subject of the da[a. The responsible aurhoricy may r.�ui;v thc rcqucsting po<sOn 14 h�y Chy�cn�al r,asrs�f mskir.g, ccr�'.:fyutg, and compiiing iht Ccrp;es. The responaible au�oriry shall cumpiy immedia[ely, if possibie,wiih any rcqu��m�da�xur�uar,c to thv subdivision,or wiihin five days of tha ds:�of thc rtqucst,excludiag Saeurdays,Sundays and fegai holidays,if ixnmediate eompiiancc;s nos possibic. If hc cannoz compiy wirh rhe raquest vE'xt�:a chat nme,he shall sfl iniflrm tite individuat.and may have an asidiaor�a;f ve dxye wi�in which w comply w�d�tha xeqaest,Exclud'u�g Saturdays, Sundays and lagal halidays. 5ubJ,4. �''rn-�du��wl�t�d�tff fs a�t aa�urate or compitt�. An irrdividua!m�y evnwst the acouracy or comptetcness vf p�lic oc pcivatG dau�t concernit►�hunsstf. To exercise chis righc,an andividuai shat!natify in WrtL3:d ihE i'G3p47tSSbIC&ULT1D�lL)d6SCflDSA4�,Lh6:18C4TC Of�1G d1390lCCII7GaC. Thc responsiblc auchorry shall wit�zin 3D days eith�r� (a�c�rrecs rht d_�a found tn be inaccurase oz incomplace an8 9uempt to natefy past recipients pf in,3c».an�or inconplrtc dan, �ticlurl;ng rcee�+ient�su�mcd by the in�+;vidu3l:or(b)norify nc�individual chac he br3iaves tha dara cc be aqrrecc. Dan in dispuce�hal1�disclosed os�y i�thc individuai's sra�emenz of disag;earns�c is incfuded wtch the disclosod ciasa. '!'!�d�r�rminnnon of�c responsibic aathonry may 6e�ppctiled gu�uanc m rhe provisions of�he adminis�rive gmcadure au relating ta caaresred cases. �aTa F�f�cY �.nvl�o�z� In accordance wi�h h1.S. 13,�4, Subd.2, "Ri�ts of subj�c�s af data", we wouid like to inform yau that your request for a permit or lic�ns� from the Ciry �F Clron� �r any of iu deg�rtuieacs �ay require yau ta furnisix certain private qr con�'id�ncial info:matiur►. You ar� iZotified that: i. The inE�rrnat:ou yuu fuiz�isIz witl'oe used to der�rm�e your quaiificacion for th�permic ar Iieense requt�sted_ 2. You rnay refuse to supg2y d�ea, but refusal may requr`re t�at �he Ciry deny che p�rmic or license. �. 'I'tze ir�formauon�vay be s�axea�vith other 1oCa1, st�«or federal ageucies to eY►e e�tt�nt�.�c�ss�ry to proczss the persnit or I�eens�. 4. If your reques[e� peXmit or li�ense reqaires Cra�cil action to app:ave, some infarruat:c�n may become pubIiG. 5. You have cenain ri�hts under M.S. 13.Q4 (avsilabie upan request) to r�view pri��ar.� data on yourself_ 6. Youi full name is required tc pracess thi5 �ppticacinn nr perosii, Mark Lester Palmer First Middl� I�Si 9815 Pioneer Trail Greenfield, MN 55357 763-498-7053 � -� - - - . �gry Stace �iP i•haae I understand my ' cs as� a: bo�r�. ,� �'�' ........__.. �o�- ...,.�j_._.--------------- Signa .—_._.