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07/0 �007 08: 24 952-935-9544 MINNESOTA RUSCO PAGE 01/01 �- ^ 1l�� Sec.13.04 RIGHTS OF 5[JB.TECTS OF bATA Subd. 1. Type af data. Thc righu of individual on whom the da�is scor�d or�o be stored shall be as set forth in rhis sec�on. . gabd.2. TnFormacion rcquired to be�'on individusl. An individuai asked ro svPP�Y Privace or co�denda!daGt coocemiog himself �,�p�;�o�ef; ��che purposo and inrended us�of the�equested dara wi�hin che collccdng s�ate agency,polirical subdivisian,or sca�ewide syscem;,(b)whether he may refuse or is lcgauy required ta supply thc reques4ed dan;(c)any]mown consequence arising from his supplying or �efusing ro suppty pcivam or conFdea�al data;and(dj rhe id�nury of oTher�ersons or enodes suthotized by sate or Rcleral law eo recCive che data. This requiremenc shall no�apply when en individual is asked co supply imesugarive da�a,pursuant to soction 13.82, subdivision 5, to a law enforeement office�. The ommissiG er of reveni�e"mav ola e fie nadt r g.uire under this suhdivi��^��n the'ndividual'nc�me�x or nmpern rcfu ie trucdons ins�ead of on those�'4 rLn�- 5ubd-3. .4�ccess to data by indiridual. •Upan�request to a responsi6le auchoriry,an individual shall be informed whether he is rhe subject of stored dara on individnals,aad whether it is classified as public,private or confidencal. Upon his further request,an individual who is che subject of soored private or public daca on individuals shall be.shown the daca wirlwut sny.charge co him and, if he desires,shall be informed - oE che con�ent and meaning.of rhac dara. After an indivulual has�been shown the privace data and inPornaed o.f iu meanin�,the data r�ed not be d;scloseG co him for siz montlu ihereaffier unless a disputc or acdoa pursuanc eo chis secdon is pandiqq or addi�ional data on�he indiviclual has been Collecxd or created. The�esponsiblc autlwriry 9hall provide copies oP the private or'public dala upon Cequest by [he individu�l subject of the data. ' The responsible auchoriry.aray.requi�rhe.r.equesdns person co pay me accuat cos�s of making;cer�ifyir�8�and compling the wpies. ' 'rhe responsible authority shall comply imillediattly,iP possible,with any request made pulsuant to dlis subdivision, oC within five days oE�he dace of rhe reques� excluding.Saaudays,Sund�ys and tegal laolidays, iP immedia�e complisace is not possible. If he alMoc comply with �he request within[hat rime,he shali so inform che individual,and m3y have�tl additioaal fYe dt►ys within wh1Ch[0�amply wiTh the rCquest, excluding Sawrdays,Sundays and legal►�olidnys• Subd_4. Procedure�ehen dsca ts not accurate nr oomplete. An individual may concest the accuracy or completeaess of pubtio or �privarr daQ concerning himself. To exerc;se�his righ�,an individval shell nocify in writing the responsible surhoriry describing ihe�nacu�c of d�e disagreemcrn. Zhe�sponsible aurlwriry shaU within 30 days ei�her. (a)corceci the dan found m be iaacou�rt or incomplex antl attemp�ro noafy p�st recipiencs of inaccurate or iaComplete dOGi,including recipients nlmed by thc indi�idual;or(b)narify the individual that he beliCves the dBCt to ye oorrect. Da�.in dispute shall be disclosed oNy iF che indi�+idual's sta�emens of disagreemen�is included wich che disclosed dara. The de�enni7�auon oFthe responsble aurhociry may be appealed pursuanc co rhe provisions of rbe admuus�rarive procedure acc relating co contesced cases. DATA PRIVACY_AD'V[SOR� In accordanca with M_S. 13.04, Subd. 2; T�ighes of subjeets of data", wc woul,d like [o 'vn�orm you chat your' �� request for a pexmit or license from th� Ciry of Orono or any of its depart�ents may require you to fumish certain private or confidential information. You are nonified thai: 1. ' The infurmauon you furnish will be used to determjne your qualifi�cion for rhe permit or licens� � . , requested. 2, You may rcfuse co supply data.but refusai may require that the Ciry deny rhe permit or license. 3, The inf6rzraaeion may be shared wzth other tacal, state or federal agencies to the extent necessary to process zhe penriit or�liaense. 4. If your requested�eruut or license requires Council action to approve, some informatioz�may beeome public. 5,.. 'You have certain rights under M,S. 13.04(available upon°request) to revxew private da�a on yourself. 6. Your full nam,e is required co proeess this applicacion or permxt_ (�,� (�d�5 � Firs^� � ��` Middle i � �� Last �� — ' , Addre s � � _2(�� 1�0�,� �-e � � ��ry � gjsce Zip Phone � /�JnlnQ .�}�� `'7 l,Z/C.� ! , y � I understan,d my eights as s[ated a ove. � •+� ��i / a Signanire 6