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Sec.13.04 RIGHTS OF SCJBJECTS OF DATA Subd. 1. Type of data. The righa of individual on whom the data is storcd or to be storcd shall be as set forth in this section. Subd.2. Information required to be givea lndIvidual. M individual uked to suppiy private or confidendal data conceraing himself shall be in(ormed of: (a) ehe purpose and intended use of the requesced data wirhur the collccdng Ycate ageacy, political subdivision,or satewide ryscem; (b)whe�hcr he may rcfux or is legally required to suppty thc'requested data;(c)any known consequence arising frotn his supplyingor refusing to�upply pnva�e or confidenrial data;and(d)the identiry of other persons or entiues'authorized by state or federal law W receive the data. 'Ihis requiremen�shall no�apply when an individuaf is asked to supply investiga4ve daa, pursuant to secdon 13.82,subdivision 5, to a law enfo�semenCo�cer. The coerunissioner of rcvenue may place the norice required under this subdivision in the individual income tax or nro�em taz refund inscrucaons �nscead of on those forms. Subd. 3. Access to data by individual. Upon request to a rcsporuible auehoriry,an individual shalt be informed whether he is the subjece of s�ored data on individuals,and whether it is classified as public, private or co�denual. Upon 6is further request,an individual who is the subjecc , of s�orcd pnvatc or public data on individuals shall be shown[he data without,any chargc to him and, if 6e desires, shall be infotmed of the con[eat and mcaning of that data. Afur'an individual has been shown[he private daa and informed of its meaning,the data need not be discloscd ro him for siz mon�hs �hcreafter unless a dispute or acdon pursuanc w chis seccion is pending or addiuonal daa on the individual 6as been coUected or creaced. The responsible auchoriry shall provide copies of the private or public data upon request by the individual subject of the data. 'Ihe�rsporuible au[horiry may require [he rcques[ing person to pay the actual costs of making, cerrifying,and compiling the copies. Thc responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision,or within five days of chc da�e of[he rcquest,ezcluding Sacu�days,Sundays and legal holidays,if immedia[e compliance is not possible. If he cuwot comply wi[h the request wi�hin eha��ime,he shall so infortn[he individual,and may have an addidonal five days within which to comply wi[h the request,ezcluding Saturdays, Sundays and legal holidays. Subd.4. Procedure w6en data is not accurate or complete. An individual may contest[he accuracy or completeness of public or privace da�a concerning himself. To exercise this right,an individual shall notify in writing the rcsponsible authoriry describing the oature of the disagreemen�. The responsible auehoriry shall within 30 days either: (a)correct the data found to be inaccutate or incomplete and atumpt to aotify past recipieou of inaccunte or incomplete data, including recipients named by the individual;or(b)notify the indi�•idual that he believes the data to be correct. Data in dispute shall be discloscd orily if the individual's statement of disagreement is includcd with the disclosed data. The detertnination of the rcsponsible authoriry may be appealed pursuant[o [he provisions of the administtadve procedure act reladng co contesced cases. DATA PRIVACY ADVISORY (n accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that your request for a permic or license from the City of Orono or any of its departments may require you to furnish certain private or conf�dencial information. . You are notified that: - I. The information you furnish will be used to determine your qualification for the pernut 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�hared 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. , �C_i� �Q''�1'�S' . �� \� ��-'Y'1 v�1 ' � ��v1��C{ v'� Firs� Middle L.ast , � �C� � �� r'LI��V 1 Address _ t�-� � v,�� -��k« M� 5�� q��s��,��_ .d��5 C�ry State Zip Phone [ e stand my rights as stat ve:� . � y� C� L� �C Nro