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� Sec.13.04 RIGHTS OF SL7B.TECTS OF D?,TA Subd. 1. Type of data. The righrs of individual on whom[he data is stored or co be stored shall be as set fonh in this secaon.� Subd.2. Information reqirired to be given iadividval. An individual asked to supply private or confidendal dara conceming hi�elf shali ba iaformed of: (a)the purpose and inrended usc of the requesud data wichin the collecang State agency,polidcal subdivision,or sratewide rysum; (b)whether he may refuse or is legally tequired co supply the tequesud data:(c)any imown coasequence arising from his supplying or refusing to supply � private or confidenrial dara;and(d)ehe idendry of ocher persoas or enrides au�horized by state or federal law to receive the dara. This requiremenc shall noc apply when an individual is asked to supply invesrigarive dara,punvanc to secdon 13.8?,subdivision 5, to a law enforcemenc o�cec — The commissioner of revenue mav place the nodce reauired under this subdivision in the individual income tax or oropertv taz refund instrucdons instead of on chose focros. Subd.3. Access to data by iadiridual. Upon request to a responsible auchoriry,an individual shall be informed whether he is the subject of scored dara on individuals,and whether it is classified as public,privace or confidenaal. Upon his further request,an individual who is the subject of stored private or public dara on individuals shall be shown che dara wichout any charge to him and;if he desires, shall be informed of the concenc and meaning of chat dara. Aher an individual has been shown the priva[e data and informed of iu meaaing,the dara need not be disclosed to him for six monchs thereaiur unless a dispute or acaon pursuant to [his secdon is panding or addidonal data on the individual has been collected or creared. The responsible authoriry s6a11 provide copies of the privace or public dara upon request by[he individual subject of che data. The responsible authariry may require[he requesang person to pay the accual costs of making,cerafying,and compiling the copies. The responsible au[horiry shall comply immediacely,if possible,wich any request made pursuant to this subdivision,or within five days of the dace of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the requesc within[hat time,he shall 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 complete. An individual may contest the accuracy or completeness of public or private data concerning}iunself. To exercise this righc,an individual shall nodfy in wridng[he responsible authoriry describing the nature of the disagreement. The responsible authoriry shail within 30 days eicher: (a)correct[he dara found to be inaccucate or incomplece and attempc to nodfy past recipieats of inaccurate or incomplete data,inctuding recipiena named by the individual; or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disctosed only if the individual's statement of disagreement is included with the disclosed data. The decerminaaon of the responsible authoriry may be appealed pursuanc to the provisions of the admicuscradve procedure act retadng to conmsted cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Righ[s of subjects of data", we would like to inform you that your request 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 permit or license. 3. ?he information raay be shared 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,�-V-� � t�. � ' I'�/d-2Sdv� F�n Middle Last 1� s w�s r (�o�� o�-., � Address �� c els�o� /�it �/ S�33c ��o -o� � � � C�ty gtace Zip Phone I understand my rights as stated above. �� . Signature