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.Ji. .._, � Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Information required to be given individual. An individual asked ro supply private or confidential data concerning himself shall be informed of: (a)the purpose a�intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b)whether he may refuse or is legally required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing ro supply private or confidential daa;and(d)the ideatiry of other persons or entiaes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesagadve data,pursuant to secdon 13.82, subdivision 5, to a law enforcement officec The cortLm�ssioner of revenue mav olace the notice rewired under this subdivision in the individual income tax or orocertv tax refw�d inscruceons instead of on those forms. Subd. 3. Access to data by indivIdual. Upon request to a responsible authoriry,an iadividual shall be infortned whed�er he is the subject of stored data on i�ividuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the dara without airy 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 meaning,the data need not be disclosed to him for six mondu thereafrer unless a dispute or acaon pursuant ro this section is peixling or additional data on the i�ividual 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 data. 11te responsible authoriry may require the requesting person to pay the acmal costs of maldng,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 immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform the u►dividual,and may have an addirional five days within which to comply with the request, excluding Saturdays,Su�ays 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 ezercise this right,an individual shall nodfy in writing the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the dara fou�to be inaccurate or incomplete and attempt to nodfy past recipients of inaccurate or it�omplete data,including recipients named by the individual;or(b)norify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the i�ividual's statement of disagreement is included with the disclosed data. The determinaaon of the respoasible authoriry may be appealed pursuant to the provisions of the administrative procedure act relating 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 request for a permit or license from the�ity of Orono or any of its departments may require you to furnish certain private or confidential information. You aze 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 shazed 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. ��, a � /�rCl� ol, �� r%f 5 F'ust Middle I.asc llCi bC7 (nlcz��C��/ l3�✓ rl• Address • /n'7r/�,� /�^�,�J J�S3QS 6��Z- S/Z-d/I � Ci�y State Zip Phone I understand my rights as stated above. v ' p $I$D3WSC 6