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� . . 1 � <br /> HP F� Series 900 _ Fa�c History Report for <br /> Plain Paper Fa7c/Copier � window lite . ' <br /> � � 612-391-6360��- � <br /> Sec.13.04 RIGKTS OF SUBJECTS OF D�TA - — - • OCt Ol ZOOI IZ:41pm <br /> �S � . e ng c�of iadividual on whom the data is scocod or w De scnc:d sha1I be u sec focch ia this section. <br /> ` Sutd.2. Inlormation nqtrired to he giv iadlr.i iadividual uk:d w supplY Privar_or q�� s�.n <br /> 6e ia.a��,. (a�rpose�:nded use of • cvithia the coIIecda3 3�t�aB=��Y.�Q��isio� c,o��s�a, <br /> (b)whec�e:he:.3y r_:vSe or u_le3alIy r_quir_d to ncppty_che r_c�uer�d da�:(c)any I�awn eaasaqueeca arisia ca his si:ppl iag or re�}�-tc�su� i• <br /> privs`p{��:�:d_c� d���( �iCeeary aCoc�4�l��T��es aucyorized by snc�arf:�e_'?_::;�s��e cho d3�. This r_q�Weac�_'! <br /> eoc a,�p��r..ea an c.�ivt�"i�a.f u u�;:d co supply invesagadve daca,pursuanc co secaon 13.82.suhdivisioa S,�a!aw eafeccemenr o�cer_ . � <br /> 'C�e ee::uaisiioner oC rever.ue mav tace che nadce r_ruird urtder chis sutdivision in the individual ir.corrse tsz or orooem t3z refur.d <br /> inmuc��}t<zd of on�hose lorms, <br /> SQK - black and white fa.�c <br /> ubd.3. Accas to data by indiriduaI. Upon requesc w a czspaasibie auchoriry,us individual shall be informed wha�her he is the subjeu <br /> of r.ac:d dsa on individaaLt,aad whecher it is et�ss�ed u pubiic,privam or eoaF.deaa�l. Upaa his furcher r_quesc,aa izdtvidaal who is c�e subjccc <br /> af stor_d priva:e or public daca on iadividnals sha11 be showa the dae wichout:ny ch3rge to him u:d;if he du'ues.shaII be infocmed ot the conteac <br /> and m:aning of�at data. Ahe�an individual has becn shown che private dacs ar.d iatormcd of ics meaaiag,the daa ne:d noc be d'uclosed to him for <br /> siz monc`u�2ser_afcer unlas a dispuee oc acaon pursuant W this secaon is peading or addidoaal dac�on the individuaI h�s been ealIec�d or erea�d. <br /> The respeasbie auc2:oriry shallprovide eopies of che privac:orpubtic daca upon requese by the individual subjecc oC�he daa. T¢e respansible auchociry <br /> may requir_ the r.qu:sdng penon ro pay che accual cosc�oC making,cerdfying,u.d comp�ling che eapiu. � <br /> The responsibfe auchoriry shaIl eampiy imr�ediacety,if possibie,wich aay request s.3de pursuant cn this subdivision,ac wichin five days of � <br /> the dam o[the teqaes�ezcluding Saturdays,Sundays and lega.l haiidays,if inrnediace compliacce is not goss3le. If he eanaot eompiy with the requesc � <br /> i <br /> within that atne,he shali so inform the individual,and may have an addidoaal five days wichia which to comply with the requut,ezcIuding Sacusdays, � <br /> Sacsdays and le3aI holidays. . . . ; <br /> 5ubd.4. Procedure�rhen daca is not aecuraee oc eamplete. An icdividual may eonc:st[he accurary or eompleceneu oEpublic arpri��ate <br /> daca eonceming tiimself. To ezeccise this right,an ir.dividual shall nadfy ia wridag[he respoas�ie auchoriry descnbing the nanire of the d'uagretmeac <br /> The res,�ocssible au�horiry shall wichia 30 days eic.4er: (a)correcc dta daca Cound to be inaccurat�or incomptet�and att:mpt to nodfy pisc recipiencs of <br /> inaccurace or incompiece data,incIuding recipieacs naraed by che individuai;or(b)coaFy the individual that he believes the daa to be corrnce Da� <br /> in dispuce shall be disciosed onIy if the individual's sca�ernent of disagrcemeat is included wi�h th�disclosed dam. <br /> The daerminadon of the responsible auchoriry may be appealed pursuant to the provisions of tha admia.isQadve pco<:dure act retaang m <br /> eonc�s�d cases. ' . . . • . . <br /> DATA PRIVACY ADYISORY � <br /> In accordance with M.S. 13.04,Subd.2, "Ri�hcs of subjeccs of data",we would like to inform you that your request <br /> for a pemut or license from the Ciry of Orono or any of iu departments may require you to furnish cercain privace or <br /> confidential information. <br /> You are notified thar. <br /> 1. The information you furnish will be used to determine your qualification for the permit orlicense requested. <br /> 2. You may refuse to suppiy data, but refusaI may require that the Ciry deny the permit or license. � � <br /> 3. The information may be shared wich other local,state or federal a�encies to the ettent necessary to procas <br /> the permit or license. ' <br /> 4. If your requested pecmit or license requires Council action to approve, some information may become ,� <br /> . public, . _ - . � - . . . � �; <br /> �5. You have certain ri�hts under M.S. I3.04�(availabie upon request) to review privace data on.yourself. . . <br /> 6. Your full name is required to process this applicatioa or permit. <br /> Fusc - tifiddle �t • <br /> . Addre.ss - -.". _ <br /> Ciry Sate Zip PCaae <br /> I understand my ri�hts as stated above. <br /> �.!7 _��� • <br /> 2��� / " �„2�/-`� . <br /> �Sigrucure . <br /> ��� -�,�- �c� - <br />