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Jan-08-2004 12:16pm From—CITY OF ORONO +9522494616 T-610 P.011/034 F-551 Sec,13.04 RIGHTS OFSVEJECTS OFDATA Subdivision 1, Type of date The rights of individual on whom the data is stored or lobe stored shall be as set forth to this section. Subd 2. Islfortnation required to be given IndividuaL An individual asked to supply private or earl fidentlal dote concerning himse y shall be informed of. (a)rhe purpose and intended use of rhe requested data within the collecting state agency,political subdivisiam or statewide system;(b)whether he may refuse ora legally requfred to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or co,#Zdential data.-and(d)the identity of otherpersons or entities authorised bystate orfederal law to receive the data, This requirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision S,to a law ertforcement officer. The commissioner ofrcvenae mav Place the norica required under thls.s hiltvision in the individual income tax or Prorierty rax refund instructions instead of on those forms. Subd 3.Access to data by builvldual. Upon request too responsible oulhoriPy an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classed as public.private or confidential. Upon hisfurther request,an individual who is the subject of stored private or public data on individuals shall be shown the data without any charge to him and if he desires,shall be informed of the content and meaning of that data 4fter an individual has been shown the private data and informed of its meaning the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created The responsible authority shall provide copies of the private or public data upon request by the Individual subject of the data The responsible authority may require the requesting person ropily the actual costs of making,certifying,and compiling the copies The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of rhe date of the request.excluding Saturdays,Sundays and legal holidays,if immediate compliance is nor possible. if he cannot Comply with the request within that rime,he sholl so inform the individual,and miry have an additionol five days within which to comply with the request,excluding Saturdays,Sundays and legal holidays. Subd 4.Procedure when data isnot accurate or cotnplere An individual mayeontest the accuracy or completeness ofpublic or private data concerning himself. To exercise this right, an individual shall not fy in writing the responsible authority describing the stature of the disagreement. The responsible authorityshall within 30 days either.- (a)correct rhe datafound io be inaccurate or incomplete and attempt io notify post recipients of inaccurate or incomplete data,including recipients named by the individual,•or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed a*if rhe Individual's statement of disagreement is included with the disclosed dale, The determination of the responsible authority maybe appealed pursuant to the provisions of the administrative procedure act relaring to contested oases. DATA PRIVACYADMORY In accordance with M.S 13.04,Subd 2,"Rights ofaubjects of data",we would like to lreformyou thatyourrequestfor apermit or license from the City of Orono or any of its departments may require you to furnish certain private or confidential information. You are notified that: I. The information you furnish will be used to determine your qualification for the permit or license requested. 2. You may refuse to supply data,but refusal may require that the City deny the permit or license. 3. The information may be shared with other local.state or federal agencies to the extent necessary to process rite permit or license. 4. lfyour requested permit or license requires Council action to approve,some Jgformarion may become public S. You have certain rights under ILLS 13.04(see fallawing page)to review private data on yourself. 6. Your full name is required to process this application or permit, PLEASE PRINT i�irst Middle Last ri7M .,-mkt vk �N Address Ptt,.f q G cityI Slat'? —— ZAP phone 1 erstand my r tt as stared ave. t uPe 10