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. � . . Sec.13.04 RIGHTS OF SUB.TECTS OF DATA Subd. i. Type of data. The rights of individual on whom the data is stored or to be stoced shall be as set focth in this section. Subd.2. Tnformation reqirired to be givm individuai. An individual asked to supply private or confidential data concerning himself shall be informed of: (a)the putpose and intended use of the requested data within the collecting�tau agency,political subdivision,or statewide system; (b)whether he tnay refuse oY is legaily required to supply the tequesud data;(c)any known conseqnence arising from his supplying or refusing to supply private or confidential data;and(d)the idendry of other persons or enaaes authorized by state or fedecal law to receive the data. This requirement shall not apply when an individual is asked to supply investigaave data,punuant oo secdon 13.82,subdivision 5,to a law enforcement o�cer. The commissioner of revenue mav nlace the nodce required under this subdivision in the individual income tax or nrovertv ta�c refund instrucdons instead of on those fo�ms. Subd.3. Access to data by indiridual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of swred data on individuals,and wherher it is class�ed as public,private or confldendal. Upon his fucther 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. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for siz months thereafter unless a dispuu or action pursuant to this secdon is pending or additional data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon roquest by the individual subject of the data. The responsible authority may require the requesting person to pay the acmal cosu of making,cerafying.and compiling the copies. The responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediau compliance is not possible. If he cannot comply with the request within that tune,he shall so inform the individual,and may have an addiaonal five days within which to comply with the request,excluding Saturdays, S�ndays and legal holidays. Subd.4. Procedure whea data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data conceming himself. To exercise this right,an individual shall nodfy in writing the responsible authority describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurau or incomplete and atumpt to nodfy past recipienu of inaccurate or incomplete data,including recipients named by the individual;or(b)notify ihe individual that he believes the data to be correcc. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determinadon of the responsible authoriry may be appealed pursuant w the provisions of the adminisuadve procedure act nlating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data",we would like to inform you that your request for a permit 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: 1, The information you furnish will be used to detemune 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 the permit or license. 4. If your requested permit or license requires Council action to approve, some information may become public. 5. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. (. Your full name is required to process this application or permit. �oG,.. �/(er� �.c 1�.c,� First Middle �t 3�So L4,r�s� rQfU� Address • kt� z.�T' . •n , s`S3 j y�S D�D 6S Ciry State Zip Phone I understand my rights as stated above. � Signaare