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Sec.13.04 RIGHTS OFSUBJECTS OFDATA l Subdivision I. Type of data. The rights of rndrvidual an whom the data rs stored or to be stored sha!!be as set forth in this sectron. Subd.2. Information required to be given individuaL An individual asked to supply private or confrdential data concerning himself shall be rnformed of.• (a)the purpose and rntended:rse of the requested data wrthin the collecting state agency,political subdivision,or statewide system;(b)whether he may rejuse or is legally reguired lo suppfy the requested data;(c)any kno�vn conseguence arising from his supplying or refusing to supply private or confidenlial data;and(d)the identity of other persons or entities authorrzed by state or federal lmv to receive the data. This requirement shall not apply when an indivrdual rs asked to supply invesligative data,pursuant to section 13.82, subdivrsron 5, to a!mv enforcement o�cer. The commrssioner ofrevenue mav Dlace the notice required under thrs subdivrsron in the individua!income tax or Droperty�ax refund instruclions rnstead ot on those forms. Subd.3. Access to data by individual. Upon request to a responsib/e authority,an indivrdiial shal!be injormed whether he is 1he subject of stored data on individuals, and whether it rs classrfied as public,private or confidential. Upon his further request,an individual who is the subject of stored private or publrc data on indrviduals shall be shown the data wrthout any charge to hrm and,if he desires,shall be informed oj � the content and meaning ojthat data. Afler an indrvidual has been shotivn fhe private dala artd rnjormed of rts meaning, the data need not be disclosed to him for six months[hereafter unless a drspute or action pursuant to lhis section rs pending or additiona!data on the individ:tal has been collected or created. The responsible aulhority shall provide copies oj�he private or public data:epon reg:�est by the individual subject of the data. The responsible authoriry may require the requestrng person to pay the aclual costs of making,cert�rng,and compiling the copies. ' The responsible authorrry shall comply rmmediately,rfpossible,with any reguest made pursuant to this subdivrsion,or within frve days of the date ojthe request,excludingSaturdays,Sundays and legal holidays,rjimmedrate complrance is not possible. Ijhe cannot comply with the request ivithin that time,he shall so inform the indrvidua/,and may have an additional five days wrthrn tivhich[o comply wrth the request,excluding Saturdays,Sundays and legal holydays. Subd.4. Procedure when data is not accurate or complete.An rndrvidual may contest 1he accuraty or completeness ofpublic orprivate data concerning hrmself. To exercise this right, an individ:�a!shall not�in writing the responsibfe authorrty describing the nature of the disagreemenl. The responsible authorrry shall wilhin 30 days either: (a)correct the data fo:rnd to be inaccurate or incamplete and allempt to not� past recipients of inaccr�rate or rncomplete data,includrng recrpients named by tlie rndrvidual;or(b)not�the indivrdua!tha�he believes the dala to be correct. Data in dispute shall be disclosed only if!he indivrdual's statement of disagreement is included with the disclosed data. The determrnation ofthe responsible aulhority may be appealedpursuant to the provisions aJthe administratrve proeedure act relatrng to contested cases. • . DATA PRIVACYADVISORY , InaccordancewithNf.S.13.04,Subd.2, "Rrghtsofsubjeclsofdata';ivetivouldliketoinformyouthatyourrequestforapermitorlicense from the City of Orono or any ojits departments may require you to furnish cerlain private or confidential injormation. You are notifred that: 1. The information you furnish will be trsed to determine your qtralifrcatron for the permrt or license requested. 2. You may rejuse to supply data, buf refusal may reguire that the City deny the permit or license. 3. The rnjormarion may be shared ivirh other local,state or federal agencies to the extent necessary to process the permit or license. 4. Ijyour requested permit or license requires Council actron to approve,some injormation may become pu6lic. S. You have certain rights under M.S. 13.04(see folloiving page)to revietiv private data on yourselJ. 6. Your fu11 name is required to process this application br permrt. PLE E PRINT ' � � � First Middle Lasl /GD �La.�,��C•� D�P. . . Address �'�vk.�.- /�'�-s� �-yr,J .S'.�.3.3/ 1�.��-4�7a- S`7/� Crry � Stale Zip Phone I underst nd my righ�s as stated above. —�� L..i�C Si ure 10 �