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� � � Sec.13.04 RIGHTS OF SLJBJE(.'TS OF DATA Subd. 1. Type of data. The rights of i�ividual on whom the data is stored or ro be stored shall be as set forth in this section. Subd.2. Informatlon reqidred to be given i�lividusl. Aa iadividual aslced to�pply private or confidential daffi concerning himself shall be informed of: (a)the purpose and incended use of the requesoed data within the collecting State agency,poliucal svbdivision,or statewide system; (b)whether he may refuse or is legally required to supply the requested data;(c)any lmown conseque�e arising from his�pplying or refusing to suPP1Y private or confidential data;and(d)1Le identiry of other persons or entides authorized by state or fedecal Iaw to reCeive the tfata. .This requirement shall not apply when an i�ividual is asked to snpply investigative dafa,pucsusnt W secdon 13.82,subdivision 5,to,a law enforcement officer. The commissioner of revemie mav olace the nofice rewired under this subdivision in the individual income tax or�rocertv tax refimd insductions instead of on those forms. S�bd.3. A�to data by indfvidual. Upon request to a responsible authoriry,an i�ividual shall be informed whether he is the subject of stored data on indiv�s,a�whether it is classified as public,private or confidendal. Upon his further req�est,an individuai 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 individual has been shown the private data and informed of its meaning,the data neefl not be disclosed bo him for six months thereafoer unless a dispute or action pursuant to this sec6on is pending or additional data on the individual has been collecud or created. The responsible authority s6all provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may requiee the requesting person to pay the acuta(costs of making,cectifying,and compiling the copies. The responsible authority shall comply immediauly,if possible,with any request made pu�suant to this subdivision,or within five days of the dax of dte request,excluding Samrdays,S�ndays and legal holidays,i�immediate comp(iance is not possible. ff he cannot comply with the cequest within that ame,he shall so inform the individual,and may have an additional five days within whic6 to comply with the request,ezcluding Saturdays, S�ndays a�legal holidays. Subd.4. Procedure whea data is mt accurate or complete. An i�ividual may contest the accuracy or completeness of public or private ' data cortceming himself. To exercise d�is right,an individual shall nodfy in writing the responsble authority descnbing the nature of the disagreement. The responsible audwrity shall within 30 days either: (a)correct We data found to be inaccucate or incompleu and attempt to notify past recipients of inaccurate or incompleu data,including recipients named by the individual;or(b)notify du individual that he believes the data to be cocrect Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The detecmination of the responsible authoriry may be appealed pursuant to the provisions of the administradve 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 City 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 w supply data, but refusal may require that the City deny the permit or license. 3. The information may 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. S��" S �� p-� '� e � t Fiist � �S� /�(or�� L�U T— Addce �j 6 (��,...� v�tC(�., ��;.� s3`PZc s�Go � �os� � City Stau Zip Phone I understand my rights as stated above. �-s— signaaue