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- :�. .. : . Sec.13.04 RIGHTS OF S[JBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be srored shall be as set forth in this secrion. Subd.2. Information required to be given individual. An individuai asked to supply private or con5dential data conceming himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting State agency,polidcal subdivision,or stacewide system; (b)whether he may refuse or is legally required to supply the requested data;(c)any imown consequence arising from his supplying or refusing to supply private or confidential data;and(d)the idendty of other penons or entides au[horized by state or federal law to receive the data. This requirement s6all not appiy when an individual is asked to supply invesogadve data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue mav place the nodce required under this subdivision in the individual income rax or property_taz refund instnicdons instead of on rhose forms. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public, private or co�dendal. Upon his funher request,an individual who is the subject of stored private or public data on individuals shall be shown the daca wirhout any charge to him and,if he desires, shall be informed of the content and meaning of that data. Afrer an individual has been shown the private data and informed of i[�meaning,the data need not be disclosed to him for siz months thereafter unless a dispute or acuon pursuant to this secdon is pending or addidonal data on the individual has been collecud or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting penon to pay the actual cosu of making,certifying, 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 time,he shall so inform the individual,and may have an addidonal five days within which ro comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when 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 notify in wriring the responsible authoriry describing[he nature of the disagreement. The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate�r incomplete and attempt to notify past 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. Dara in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The detecminacion of the responsible authority may be appealed punuant to the provisions of the adminisaative procedure act relaung co 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 pernut 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 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 a;encies to the eztent necessary to process the permit or license. 4. If your requested pernut or license requires Council action to approve, some information may become public. $, You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. 6. Your full name is required to process this application or permit. I�Yw�� G i�/�OrP� ,v �P `SGy1/ ��• - First Middle �� ��Dl �`��' �� '�u� Address ��SL/� / �? 3 �7 J 2� c��,n�`r�v S �� c.J rySta� Zip Phone I understand my righ as stated above. � � � V �/ Signaturo