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May 17 05 09: 43p FIDELITY INC 6512574223 p. 2 <br /> Sec.13.04 RIGH7'S�F SUBJECfS OF DATA <br /> 5ubd.1. Typc of data. The rights of individua!on whom the data is stored or to be stored shall be as set forih in this section. <br /> Subd.2, lnformationraquiredtobegivenindividual.Anindividualaskedtosupplyprivateorconfidentialdataconceminghimselfshallbe <br /> infortned of: (a)the purpose and intended use of the requested data wilhin the col lecting sfate agency,political sobdivision,or s�ntewide systam;(b) <br /> whether he may refuse or is legally required to supply the requested data;(c)any known wnsequence azising from his supplying or refusing to supply <br /> private or confidential data;and(d)the identity of othet persons or entities authorized by state orfede�al lawto receive thedata,This requirement shall <br /> not apply when an individuel is asked to supply investigative data,pursuent to section 13.82,subdivision 5,to a law enforcement officer. <br /> Thc commissioner of revenue mav�lace the notice rcguired under this��i�+vicinn in th��.+��..��„�I income tax or oro r+.��ax refi��� <br /> instructions instead of o�those fortns. <br /> 5ubd.3. Access to data by individual.Upon request to a rcsponsible authority,en individual shall be infortned whethen c�is the subjectof <br /> stored data on individuals,and whether it is ciassi fied ns publ ic,private or confidential. Upon 6is fuRher request,an individual who is the subject of <br /> swred private or public data on individuals shall be shown the data without any chatge to him and,ifhe desires,shall be infortned of the content and <br /> meaning of that data. Af1er an individual has been shown the private dala and informed of its meaning,the data need not be disclosed to him forsix <br /> months chereaftcr unless a dispute or action pursuant to this section is pending or additional data on the individual hes bcen collected orcrealed. The <br /> responsible aulhority shall provide copies af the priva[e or publ ic dala upon request by[he individual subject of the data. The responsible authority <br /> may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. <br /> The responsible authoriry shall comply immediately,iFpossible,with any requcst made pursuant to this subdivision,or within five days of <br /> thedateoftherequest,excludingSaturdays,Sundaysandlegalholidays,ifimmediatecomplianceisnotpossible. Jfhecannotcomplywilhtherequest <br /> within that time,he shall so inForm the individual,and may have an additional five days within which to comply with the request,excluding Saturdays, <br /> 5undays and legal holidays. <br /> Subd.4. Procedurewhendataisnotaccurateorcomplete.Anindividualmaycontesttheaccurdcyorcompletenessa('publicorprivatedate <br /> conceming himself.To exercise this right,an individual shall notify in writing the responsibleauthority describing the nature of thedisagreement The <br /> responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of <br /> inaccurateor incomplete dat�including recipients named by the individual;or(b)notify the individual that he bel ieves the datam be correct. Data in <br /> dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The detertnination of the rasponsible authority may be appealed pursuant to the provisions ofihe administrative procedure act relating to <br /> wntested Cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.o4,Subd.2,"Rights of subj ects of data",we would like to inform you that your request <br /> for a permit or license from the City of Orono or any of its depar[ments may require you to furnish certain private or <br /> confidential information. <br /> You are notified that: <br /> l. The information you fumish will be used to determine your qualification for the permit or license <br /> requested. <br /> 2. You may refuse to supply data,but refusal may require that the Ciiy deny the permit or license. <br /> 3. The information may be shared with other local, state or federal agencies to the extent necessary to <br /> process the permit or license. <br /> 4. If your requested permit or license requires Council action to approve,some information may become <br /> public. <br /> 5. You have certain rights under M.S. 13.04(available upon request)to review private data on yourself. <br /> 6: Your full name is required to process this appli on or permi[. <br /> � �. ��►�.�..�2..+� <br /> First Middle Lact <br /> � �'?�t�¢� �t�' `�`' �� <br /> Address <br /> l��• v '1 -G�Z ��l l Z�'1 � �-1 tl�- <br /> City ,� State Zip Phone <br /> 1 un a my ' ht s stated above. <br /> J <br /> IV <br /> Sien <br /> 32 <br />