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DEC/04 2009/FRI 10' 30 AM Groom �onstruction FAX No. 952-929-4779 P. 002
<br /> Sec.13.04 Ti�GY�TS Or SUBJECTS OFAA,TA
<br /> Sybd.I. Type of data, Tho riglits of individual on whom tbe dara is acored or�o be stored ahell be as set fortl,in this sectioa.
<br /> Subd.2.Infosmation required to be given individual.An indivadual asbed to aupp�y private or con�derrtial daCa concercxinB himself sha(I be
<br /> infocmed of: (a)the purpose and intenfled use of the requesied data wlthln ihe collectipig state agency,political 9ubdivisiop,or atatewide aystem;(b)
<br /> wPJether he may iefuse or is tegally rCquirCd to supplythe tequesCed data;(c)any known consequence arising froIIt hie supplying or I�fusing to sup�ty
<br /> privete of eonf aentfe)uata;and(d)the 7dentity oPother persans or euddes authorined by smte or fadcmllawto rcc�ive rbe dem,Thie rLquiticn�nesheU
<br /> 110L SppIY WkIRC1,p11 IAd7VIdllPl aA AA�CGd tA ALI�IY IIiVGT.L161�tIVG dAFd�parsuaet to section 13.82,subdivieion 5,to a law enforceroent o�cer. , �
<br /> �1 e commi96ionei of rev nue mav olece the nqri�esr QLired�nder this c_�bdivision in the individLel ineome tax or pronem tax I�eefund
<br /> insmict;ons inscead oton moae rprms.
<br /> Subd.3.Access to date by individual,Upon request�o a responaiWe aut�ority,en individual shell be informed whetheshe istl�e subjecC of
<br /> stored deta on individuals,and whether it is classified as pubf ic,p�ivace or co�de�,tial. Upon his further request an individual who is the subject of
<br /> s[ared private or public daca on ineiviQuals shall be shown rl�e Uara wiqaou�aqy cbarge�o r,iin end,Sf he desires,aha11 be intbrmed aPtfie�oncent and
<br /> meening of thpt detA. Aifier an individual has been shown[}le private data and in�olmed o�iCg meQning,tlae data need not be disclosed to him for six
<br /> montha therea�er unless a 8ispu6e or action pursuant to this section is pending or addicional deta on the ibdividual has beep coUected or created.The
<br /> responsible ay�horiry ahall provide oopies of the private or public data upon reques[by the individunl subject ofthe data. '�he r�eponsible auchoriry
<br /> m8y leqylie tt��eque8tlpg person[o pay[he ectual costs of mflking,cetUfj�ing,and Compiling[tte copies.
<br /> �'hp IcesportsAb]e authority sh¢11 wmply immediotely,if possiblB,with any xquesc made pursvant�o this aubdi�ieion,oz w�tbio fve dpyp of
<br /> tha date of ek►e Feques�excluding San,rdays,Sundays and legal holidays,if immedi0te Comp1ienca IS notpossible.Ifhe cantloi comply widat}ae[equegt
<br /> within tha[tirqe,ha shaU so inform the individusl,and mey have an edditional five days within which to comply with the Yequesi,e�xcluding Satu�days,
<br /> sundays ana lpgal ho110ays.
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<br /> Subd.4. Procedure when data is not accuraoe or coroplete.An indivaduai may conteatthe accucacy or completeness ofpublic orprivate data
<br /> concerning hitpself To exsicise chis right,an indivldusl s11all,noti�y In wAating tlac[ea�onaibte authority describing the natu�E of the disagreemenC The
<br /> responsible authority shall wiihin 30 days eiilter: (a)cornect the data�ound tp be j�accu�ate or incomplete and etbempt to notify past recipients of
<br /> in�oumbo or iacomploke dats,including racipienta nam�d by the individual;or(b)noufyr}za a�d�v�dua��as he be�9eves ehe dsm Mo be ooireot.batn in
<br /> dispu�e she11 be disclosed only if the indivi8ual's staoemene of disa�reement is included wiith�he disclosed da�
<br /> 'Z'he determination of the responsible euthority may be appe8led putsuSrlt to The provisions of tlle admlxlisLTacive procedyre act�relatjpg so
<br /> conre9�d ceaqe. _
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<br /> AATA.PRIVACY A bVTS�x2Y
<br /> � Zn aeCOrdance wat�,NZ.S.Z 3_�4,Subd.2,"Ri,gk�ts of su�j ects of data",we would like to inform you thaY your rec�uest
<br /> for a pecmit or license fro�a7 t�,e Cxty o�Oabqo or any of its departments may reyuire you to furnish certain private or
<br /> confidential.a�.fonc�ation. . ' . .... . .
<br /> Xou �e not�fjed that:
<br /> 1. � The informaCion you fumish wi.l� be vsed to dete�x�7une your quallfication for the permit or liccnse
<br /> rec�uested '
<br /> 2. You may ze:Puse to suppay data,but xe�usa�1oo,ay xequlre that the City deny[hc permit or liccnsc.
<br /> 3, 'X'he iut£ozzn,ataoz� zz�ay be shared with other lo�al, ststc or fcdcral ogcncics 'to thc cxtet�t neeessaxy to
<br /> p1'ocess the permit or license.
<br /> 4- Z£your requested permit or liC�nse rec�uires Council aGYio�l to approve,soaxl,e�ix��o�at'tpm utay becppae
<br /> publia
<br /> S. Y�ou have certain xights under IvI.S. �3_04(avai.l.able upox►xequest)to review pxivate data on yoursCl:E:
<br /> 6_ Xow fu�l narne xs xequ��ed to gxocess t�is application oX pern►it.
<br /> Tirst �Iddlc Lact
<br /> A,ddr�s
<br /> Clty State zip Phopc
<br /> X u�p�daxsta d my rights as stated abwe.
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<br /> Stgn�tuc�
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