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JUN.25'2004 12:12 6127229754 GARLOCK FRENCH ROOFING #5245 P.005/006 <br /> Sec.13.84 RIGHTS OIFSUaJRC7'S OF DATA <br /> Sated.I. Type of data. The rights of Individual on whom the data is stored or to be stored shall be as set forth In this section- <br /> :ON.2. Information required to he given individual.An individual naked to supply private orconfidential date concerning himself droll be <br /> Informed of: (a)the perpnee and intended uta of the requested data within the collecting state agency,political subdivision,or statewide system;(b) <br /> whether he may reface or is/legally required to supply the requested data:(c)any known ceesoquonce arising from Pile enppiying or ralh,Ing to supply <br /> private or conlldantlal data;and(Odle Identity of other persons or entitles authorized by/tate or rderal law to receive the data.This requirement/hall <br /> not apply when an Individual Is naked to supply Investlgntive data,pursuant to section 13.82.rwbdtvlelon 5,to a law enforcement officer. <br /> The cammlsalaner.afreyenna may nine lbanallrr clanked under this auhdlvlalon In the Indlddaal Income tea or ar,onerty lax retinal <br /> Jantruednna instead of on those forme. <br /> Sehd.3. Access to data by Individual. Upon requital ton responsible authority,an individual shall be informed whether be Is the subject of <br /> stored data on lndividuala,and whether It le classified as public,privateer conlldentd. Upon hie bather request,an Individual who IF the subject or <br /> stored private or public data on Individuals shall he shown the data without any charge to him nail,Whe desires,shell be informed of the content and <br /> meaning of that data. After an Individual hie been shown the private data and informed of ire meaning,the data need not be disclosed to him for ale <br /> months thereafter sinless a dispute or action pursuant to this saction is pending or nddttlonal data on the individual has been collected or created.The <br /> responsible authority shall provide copies of the private or pnblie flats noon request by the individual object of pito date.The responsible enthotity may <br /> require the requesting porton to pay the actual costs of molting,certifying, and compiling the copied. <br /> The responelble authority shall comply immediately,if poselbk.with any request made pursuant to dice auhdivhdon,or within five day/of the <br /> date of the request,excluding Saturdays,Senday/end lagnl holidays,if immediate compliance Is not powlhia if he cnnuor comply with the request within <br /> that time,he shall en inform the individual,and Puny have an nddittonni live days within which to comply with the roost,excluding Saturday..Sundays <br /> end legal holidays. <br /> Sated.4.Procedure when data Ie not accurate or complete.An individual may contest the accuracy or completeness/of public or private date <br /> eoocerisinghimself To exercise this right,no individual eball notify In writing tbe reeponeible authority describing Hie online of the disagreement.The <br /> responsible authority shall within 38 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify pact recipients of <br /> Inaccurate or incomplete data,Including recipients named by die individual;or(b)notify the indiidual that be believes lite date to be correct.Data In <br /> dispute shall be disclosed only If the Individual's statement of disagreement in included wok the dirrioFed data. <br /> The determination of the responsible authority nosy be appealed pennant to the provisions of the administrative procedure act relating to <br /> contested costes. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S.13.04,Subd.2,"Rights of subjects of data",we would like to inform you that your request <br /> for a permit or license from the City of Orono or any of Its departments may require you to furnish certain private or <br /> confidential information. <br /> You ore notified that: <br /> 1. The information you furnish will be used to determine your qualification for the permit or license requested. <br /> 2. You may refuse to supply data,but refusal may require thin the City deny the permit or license. <br /> 3. The information may he shared with other local,state or federal agencies to the extent necessary to process <br /> the permit or license. <br /> 4. If your requested permit or license requires Council action to approve,some tnformtatlon may become <br /> public. <br /> S. You have certain rights under M.S.13.04(available upon request)to review private data on yourself. <br /> 6. Your full name is required to process this application or permit <br /> j1 <br /> r Vet v r• d C�,�,�y��,��r <br /> First Middle Lest <br /> 3 01 y 6-6 11 14,Kn < <br /> Address <br /> M pp Moi , <br /> 15 . _ 5-5"-Lie G I a - 2 76.-99a. <br /> eddy Slam Zip Phone <br /> I understand my rights as stated above. <br /> signature <br /> + : <br />