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� - � Sec.13.04 RIGIiTS OF SLJBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is storcd or to be stored shall be as set forth in this section. Subd.2. Information reqirired to be given individual. An individual asked to suppiy private or confidendal data concerning himself shall be informed of: (a)the purpose and intended use of the requesud data within the collecaag"stare agency,poliacal subdivision,or sratewide system; (b)whether he may refuse oY is legally required ro supply the requesud data;(c)any�own consequence arising from his supplying or refusing to supply private or confidenaal data;and(d)the idendry of other persoas or enddes authorized by state or federai law to receive the dara. This requ'uement shall not apply when an individual is asked to supply invesdgadve dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav place the nooce reauired under this subdivision in the individual income tax or propertv rax refund instcucdons instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsibfe authoriry,an individual shall be informed whether he is the subject of s[ored data on individuals,and whe[her it is classified as public,priva[e or confidenaal. Upon his further request,an individual who is the subjecc of stored private or public dara on individuals shall be shown the data withouc any charge to him and;if he desires, shall be informed of the content and meaning of that dara. After an individual has been shown the privace data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acdon pursuant to this secdon is pending or addidonal dara on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the dara. The responsible authoriry may require the requesting person to pay the actual cosu of making,certifying,and compiling the copies. The responsible authoriry shali 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 immediate compliance is not possible. If he cannot compty with the request within that time,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,exciuding 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 concerning himself. To exercise this right,an individual shall nodfy in wridng the responsible authoriry describing the nature of che disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of inaccumte or incomplete data, including recipients named by the individual: or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included wi[h the disclosed data. The determinaaon of the responsible authoriry may be appealed pursuant to the provisions of the administradve procedure act telating to 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 reques[ for a permit or license from the Ciry 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 perm.it or license. 3, The information may be shared with other local, state or federal a;encies to the extent necessary to process the pemut 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. � �� �� ' � ��-+C � � �l�� L �- First Middle � Last ��(z�' �I-I 1� ►� y C.t ; Ci��' I��` ' - , Address — j-� �C --7 sy� � 7 ,�.� r� ,< 1�11 ti � >- > l I � � 1 �; .:��. Ciry Srare Zip Phone I understand my rights as stated above. , C.. . �+ � , Signature