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, Sec.13.04 RIGHTS OF S[TB.JECTS OF D�T,� Subd. 1. Type of data. The righrs of individual on whom che data is stored or to be stored shall be as set forth in this secaon. Subd.2. Information reqirired to be given individual. P+n individual asked to suppiy private or confidendal dara concerning himself shall be informed of: (a)the purpose and intended use of the requested data within tbe coilecting"state agency,polirical subdivision,or sratewlde system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any known coasequence arising from tus supplying or refusing to supply private or confidenrial data;and(d)the idenrity of o[her persons or enriaes au[horized by state or federal law to receive the data. This requuement shall not apply when an individual is asked to supply invesrieadve dara, pursuan[ro secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue r�av place the noace reauired under this subdivision in the individual income tax or propertv rax refurni instruc[ions instead of on those forms. Subd. 3. Access to data by indi�zdual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals, and whe[her it is classified as public, private or confidential. Upon his funher request, an individual who is che 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 oi�he content and meaning of[hat data. Afre�an individual has been shown the private data and informed of ics meaning,the dara need not be disclosed to him for six months thereafter unless a dispute or acrion pursuanc to this secdon is pending or addidonal data on the individual has been collected or created. The responsible au[horiry shall provide copies of the private or public data upon request by the individual subject of rhe dara. The responsible authoriry may require the requesting person to pay the acrual costs of making, certifying, and compiling the copies. The responsible authoriry shall comply immediately, if possibie, 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 immedia[e compliance is not possible. If he cannot comply with rhe request within that time,he shail so inform the individual,and may have an addidonal five days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or compiete. An individual may contest the accuracy or completeness of public or private data conceming himself. To exercise this rieht,an individual shall nodfy in wricing the responsible authoriry describing[he nature of the disagreemenG The responsible authoriry shal(within 30 days either. (a)correct che data found ro be inaccurate or incomplece and attempt to norify pasc:ecipients of inaccurate or incomplete data, including recipients named by the individual;or(b)nodfy the individual[hat he believes the data to be correcc. Data in dispute shali be disclosed only if the individual's statemen[of disagreement is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant ro the provisions of the adminiscrarive procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Ri�hts of subjects of data", we would like to inform you that your reauest for a permi[ or license from the City of Orono or any of its departments may require you to fumish 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 pemut 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. (, Your full name is required to process this application or permit. � C.. �-c_ .�y,�-� --�r-2�Go First / Middle � Last l � � — 'i_�� / • Address � � S 5 3 � � �l�- %� %� i �,; �i ��L Z' - City .� 5tate Zip Phone I understand my rights as stated ahgve. r --- � 6� ��`-��' Signature