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�► _ Sec.13.04 RIGHTS OF SUBJECTS OF DaTA Subd. 1. Type of data. The righ�s of individual on whom[he data is stored or to be scored shall be as set forth in this secdon. Subd.2. Information reqirired to be given indiridual. An individual askcd to supply private or confideorial data concerning himself shall be informed of: (a)che purpose and iacendcd use oE the requesud dara within the collecang'stace ageacy, polidcal subdivision,or statewide rysum; (b)whether he may rtfuse or is legally required to supply the requesced data;(c)any Irnown consequence arising from his supplying or refusing to supply privace orconfidenaai daca;and(d)the idendry of other persoas orendaes auchorized by sta[e or federal iaw to receive[he data. This requiremenc shall not arply when an ir.dividual is asked to supply invesrigadve dara, pursuanc to secdon 13.82, subdivision 5, � a law enforcement officer. 'Che commissioner of revenu- mav plac� che noace reauired under this subdivision in the individual income nx or vropem raz refund instrucdons insc_ad of on chose forms. Subd. 3. Access to data by individual. Upon requesc to a responsible aurhoriry,an individual shall be informed whether he is ehe subjecc of scored data on individuals,and whecher it is classified as pubiic,private or confidendal. Upon his further request, aa individual who is the subjecc of stor:d private or public dara on individuals shall be shown[he dara wichout any charge to him and, if he desires, shall be informed of the contenc and meaning of�hat data. After an individua!has be�n shown�he private data and informed of ics meaning,the data need not be disclosed to him for six mon�hs chereaftcr unless a dispute or acdon pursuanc to chis secdon is pending or addidonal data on the individual has been collecced or crea�ed. The rsponsible authoriry shall provida copies of[he privac�or public data upon request by the individual subjecc of the daca. The responsible authoriry may require [he requesdng person to pay the actual cosu of makin¢, cerdfying,and compiling the copies. The responsible au[horiry shall comply immediatzly, if possible, wich any request made pursuant to chis subdivision,or wi[hin five days of the dace of the requzst,excluding Sacurdays.Sundays and legal holidays,if immedia�e compliance is not possible. If he cannot comply with the request wi�hin[hat dme,he shali so inform the individuai,and may have an addidona!five days within which to comply wi[h the request,excluding Sacurdays, Sundays and legat holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private dara concerning himself. To exercise chis right,an individua!shall noafy in wriang�he responsible auchoriry describing the nanire of[he disagreemeac. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attemp�to nodfy past recipien�s of inac:urate or incomplete data, including recipiencs named by cbe individual; or(b)norify the individual tha�he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statemenc of disagreement is included with the disclosed data. The decerminadon of[he responsible au[horiry may be appealed pursuanc to the provisions of the adminis[rarive procedure act reladng to contested cases. DATA PRTVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Righcs of subjects of data", we would like to inform you that your request for a pernut 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 wiil be used to determine your qualification for the perm.it 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 wich o�her local, state or federal a;encies to the eetenc 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 ri�hts 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 permi�. ��I`Uf�-�' � �� t v� �� `�--L' Firsc �fiddle Last Address Ciry Sra�e Zip Phone I underst d my '�hts �s stated a ve. / � Signa[ure