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Aua-20-2002 12:52pm From-CITY OF ORONO +9522494616 T-874 P.003/003 F-586 Scc.13.04 RIGH'FS OF SUBlEC'fS OF DATA � Subd. 1. Type of dasa. 7he rig6u of individual on whop�rbe data is sw�ed o�[o bt 5oored shall be as set forth in this sccqop. Subd.3. Informa�ioe requtred to he�i�ea individusl. ,an ii,dividva!asked eo supply privao�or confideeasl data coaceening bimself shall be informed oP� (a)rhe purposc and 'en��ded use oP tlre requesx+d daia wishia d�e collccdng§�a[e ageeey,potidcal subdivision,or sffitewide syscem; (b)wherher he may retuse or is le,�ally�equind oo suQply the Rr{uesud data:(c)an,y imow�e consequence arisiag froro his saPP�Y�or reCitsing�o suFP�Y privace or aonfidendal dard:aesd(d)the idendry of o�her persoas or enc[ie�authOrized by snpe Or fcderal law�o racaive tho da�a. 'Phis requiremcn�shaii noc apply when an individu�l is asked io supply invesrigadve data,pursuaat ro secaon 13.83,subdivision 3,to a law enforeemene o8fcer. The cornmissioner of ee�-enue ma� �lace �he nocec se�i� under dees subdivision in rhe individusl inaame e�x or orooerev raz rcfi,nd inscruccions_ins�ad of an chose Forms. Subd.3. Access to data by'uidividu9i. Upon�ryuen w a responsible aurhoriry,an individusl shall be iaformed wherher he is r6e subjec� of sw�ed da�a on individuals,s�whee�er ie is classified as pubGc,privare or eonfidenrial. Upon his fiuiber nques�.aa individual who ia�hc subjac� of snored private or public ds�a on i�sdividuals shall be s6own the da�a wid�out any charge to hisn u�d;if he desires,shaU 6e infottned of ehe�on�ent and meaning of d�s[da�a. After an individual has heea shown du privare daca and ioformed of ics maaaing,me data aecd no�be disclosed w him for six moedu d�e�afozr un(ess a d'upuu or acdon pursuam w dsis secaon is pending or atldiaoosi da�on d�e individual 6as be�n collccccd or creaced. The responsibie au�ho�ry shall provide copies of dte priva�e or public dara upon rrquest by the individua!subjeci o[[he data. Thc responsible Aushoriry may requi�e rbe�ques[ing pz�sOn to pay the acival cosrs of m�lcing,cersitying.and compiliag the eopies. • 'I'ho rcsponsible aurho�ry sbaU comply immediarely,if possible,wich any�quest made pursuant ro zhis subdiviaion,or wi�hin�ive days of rhe da[e of�he requese,exduding Samrdays.Sunday3 and lrga!holidays,if irtunediau campiiance is no�possible. If qe canno�comply wid�d�e requesc wirhin�hae amr,ha sHalt so inlorm che individual,end may hava an addioonal five days wirhin w6ich to eompEy wid��he reqyes[,eaelueiag San,�days, 5undays and legal holidays. Subd.4. Procedure witea data is aot aceurate or eamplete. An individua[may oon�es�rhe acouracy or complereness oF public oe pri�•aie dara eoacaming himselP. To exercise d�is righe,an individual shaU nadfy in wricing�he rrsponsible au�horiry describing d�o nan,��e oP ehd disagreemenc. The responsible aud�oriry sbalt within 30 days eir�cr: (a)coaec�ihe dara found ro be inaccurace or iacomplrsc and aaempc co nority past recipina�s of inaccurs�e or incomplex da�a,including rrcipiertes named by�he;�dividual;or(b)aorify rhe individual�ha�he believes�hc dara co be co�rect, Ds�. in dispua shall t�c discleszd only if ehe individual's seaccmen�of disagrcamenc is iacludad widt che disclosed dam. The daecminadon vf the respoasihle aurhoriry may be appealed pursuaac m rhe provisions of the admiaisaacive ptocedure act relaaag to conecsced Cases. • DATA, PRNACY ADVISORY In accordance with M.S. 13.04, Subd.2� "lti,ghu of subjeccs of data",we would like co inform you thac your requesc for a pernu� or license from the City of Orono or any of ics depanmen�s may require you [o furaish certain private or confideatial infArmation. You are natified that: 1. The information you furnish will be used to determine your qualification for zhe peraiit or licen,se requested. 2_ You may refuse to supply data, but refusal may require iha� the City deny the permit ar license, 3_ The Infotmation may be shared with o�ter local� state or federal agenCies to the extent necessary to process che permic or license. ' 4. If your requeste� percnit or license requires Couneil ae�ion cq apprvve, some infotmation may beepme public, 5. llou have cenain rights under M.S. 13.04 (available upon request) io review pnvate data on yvurself. 6. Your full name is required co process �his applica�ion or permic. Verena Laura Pearson p�� Middle Lasc 20 Mvrtle Rc�ac� Atla�eu Wayzata, MN 55391 952.473.5237 ��y Sace 2ip Phone I understand my rights as stated above. ��-�-��-a--«- �-21-U2 , Sigtta[ure �