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Sec.13.04 RIGHTS OF STJBJECTS OF D�►TA Subd. 1. Type of data. 'Ihe rights of individual on whom[he data is stoced or to be stored shall be as set forth in this secaon. Subd.2. Information req�red to be pvm individnal. An individual asked to supply private or confidendal data concerning himself shall be informed of: (a)the putpose and intended use of the requested data within the collecang Stare agency,polidcal subdivision,or satewide rysum: (b)whether he may refuse oY u legally cequired to supply tt►e requesud data:(c)any]mown coauquence arising fmm his supplying or refusing to supply priva[e or confidential data;and(d)the idenriry of oeher pecsons or enades au[horized by state or federal law to receive ehe data. This requirement shall not apply when an individual is asked to supply investigadve data.Qunuant to secdon 13.82,subdivuion 5,to a law enfoccement officer. The commissioner of revenue mav vlace the nodce reauiced under this subdivision in the individual income tax or proaertv tax tefund instrucaons instead of on those forms. Subd. 3. Access to data by individual. Upon request to a cesponsible authoriry,an individual shall be informed whether he is the subject of stoced data on individuals,and whe[her it is class�ed as public,private or confidendal. Upon his further cequest,an individual who is the subject of smred private or public data on individuals shall be shown the data wirhout 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 meaninq,the data need not be disclosed to him for six months thereafur unless a dispute or acaon pursuant to this secdon is pending oc addidonal data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon cequest by the individual subject of the data. The responsible authority may tequire the roquesdng person to pay the actual costs of making,certifying,and compiling the copies. The responsible authoriry shall comply immediately,if possible,with any request made pucsuant to this subdivision,or within five days of the date of che cequesc,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comp(y with the request within that time,he shall so inform the individual,and may have an addirional five days wi[hin which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data ts not accurate or complete. An individual may contest the accuracy or completeness of public or private data conceming himself. To exereise[his right,an individual shall noafy in wridng ehe responsible suthoriry describing the naare of the disagreement The responsible au[horiry shall within 30 days either: (a)corrcct the data found to be inaccurarc or incompieu and aaempt to nodfy past recipienu of inaccurate or incomplete data,inctuding recipienrs named by the individual;or(b)notify the individual that he believes the data to be correc� Data in dispu[e shall be disclosed only if the individual's statement of disagrcement is included wirh the disclosed data. The determinaaon of the responsible auchoriry may be appealed punuaat to the provisions of the administradve proceduro act relating ro contemd 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 Ciry 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 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. 6. Your full name is required to process this application or permit. �/�� /�/E � r� �� Fint ,,�/ Middle / Lasc --�—E�—� � � l 7 �9-� � � ,� n�,Q (C-� Address S S 3 �J � V(/ ��$�� / Ciry Stace Zip Phone I understand my rights as d above. . � � Signamre