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� Sec.13.04 RIGHTS OF SUBJECTS OF DATA � Subd. 1. Type oP 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. InformaHon required to be given individual. An individual asked to supply private or confidenaal data concerning himself shall be informed of: (a)the purpose and inte�ed use of the requested data within the collecting srate agency,poliacal subdivision,or statewide system;(b)whether he may refuse or is legaUy required to supply the requested data;(c)any Imown consequence arising from his supplying or reCusing to supply private or confidential data;and(d)the identiry of other persons or endaes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesdgadve data;pursuant to secrion 13.82, subdivision S, W a law enforcement officer. The commissioner of revemie mav nlace the notice rewired under this subdivision in the individual income taz or orooertv tax refund instructions instead of on those forms. . Subd.3. Access to data by individual. Upon request to a responsible authority,an i�ividual shall be informed whether he is the subject of stond 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 data without any charge to him and,if he desires,shall be informed of the content and meaning of that data. After an individua!has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafur unless a dispute or action pursuant w this secdon is pending or addiaonal data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon nquest by the individual subject of the data. The responsible authoriry may require the requesring person to pay the acaal cosu of maldng,cemfying,and compi6ng the copies. The responsble authoriry shall comply immediately,if possible,with azry request made punvant W dus 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 individual,and may have an addidonal five days within which w comply with the request, exclud'wg 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 concerning himself. To exercise this right,an individual shall nofify in wriang the responsible authoriry describing the nature of the disagree�nt. The responsible authoriry shall within 30 days either: (a)correct the data found ro be inaccurate or incomplete and attempt to notify past recipients of inaccurate or ic�omplete data,i�luding recipiencs named by the individual;or(b)noafy 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 with the disclosed data. The determinadon of the nsponsible authoriry may be appealed pursuant to the provisions of the adminisoradve 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 depaztments may require you to furnish certain private or confidential information. You are notified that: 1. The information you fumish 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. `` ��1�'�'�.�0 �� Fi bfiddle Last ,�'�� /�� G��?�! f'}2t2.� � c��i� '�'`/7�' Address /��,�A/ ��I �/ ��SlJ S�� /v��/��3�� iw City State ZiQ Phone I under y 'ghts as stated above. si � 6