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r` . Sec.13.0-1 RIGH'TS OF SUBJECTS OF DaT,�, Subd. 1. Type of data. "Ihe righ�s o[iadividual on whom the data is scored or w be stored shall be as sec forch in this secaon. Subd.2. Information reqtrired to be given individual. An iadividual asked to supply prn•are or confidendal data conceming himseif shall be informed of: (a)the purpose and intended use of che requurcd data wi[hin the colleccing'state ageacy,polirical subdivision,or sratewide system; (b)whe[her he may refuse o`r is legally required to suppty tbe requested data;(c)any imown coasequence arising from his supplyin�or refusing to supply private or conndential data;and(d)the idenaty of orher persons or ennties authorized by sca[e or fede�l law to receive the data. This requirement stiall not apply when an individual is asked to supply invzsaearive dara, pursuant to secrion 13.82, subdivision 5, to a law enforcemene o�cer. The commissioner of re�e�ue mav pla- the nodce reauired under this subdivision in �he individual income tax or propertv raz refund instrucrions insiead of on chose forms. Subd. 3. Access to data b�indi�iduaI. Upon requesc to a responsible auchoriry,an individua!shall be informed whether he is the subjecc of s�or`d daca on individuals, and whe�her it is class�ed as public, privace or confidenaal. lipon his funher rquest, an individual who is the subject of stor:d privace or public dara on individuals shall be shown�he dara wichout any charge to him and, if he desires, shall be informed of t�e concenc and meaning of chat data. After an individual has bezn shown the private data and informed of ics sesning, the data need not be disclosed to him for six months thereaiter unless a dispute or acrion pursuan[to this secrion is pending or addiaonal dan on the individual has been collected or crea[ed. The responsibie auehoriry shall provide copies of th�private or public data upon request by the individual subject of the data. The responsible authoriry may require che requesring person to pay the acnial costs of makine. cerdfying, and compiling the copies. The responsible au[horiry shall comply immedia[ely, if possible, with any request made pursuant to this subdivision, or wi[hin five days of the dace of che request,excluding Saturdays,Sundays and legal holidays,if immedia[e compliance is r,oc possible. If he cannot comply wi[h the request wi[hin;hat time,he shall so inform the individual,and may have an addidonal five days within which to comply wi[h the request,excluding Saturdays, Sundays and lega(holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest�:e accuracy or compte[eness of public or pm�ate data conceming himself. To exercise this right,an individual shail nodfy in wriang che respoasible au�^oriry dzscribing the nature of the disagreement. The responsible authoriry shall within 30 days ei�`:er. (a)correct che data found ro be inaccurace or ir.comple:e and attempc to nodfy past recipienu of inaccunce or incomplete data, including recipieacs named by the individual; or(b)nodfy the individual thac h�believes the data to be correct. Data in dispuce shall be disclosed only if the individual's statement of disagreement is included wi[h the duclosed dara. The decerminarion of the responsible au�horiry may be appealed pursuanc to the provisior.s of[he administracive procedure act reladn, to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data", we w�ould like to inform you that your request for a pernut or license from the City of Orono or any of its departments may require you to furnish certain private or confidential information. You are notified that: 1_ The information you furnisn 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 Ciry deny the pemut 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. �, You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. 6, You� full name is required to process this applica[ion or permit., /'��/ ��J _� 1 � f.��7��LCv-:>�----_ i�'" � Firsc ` 1 �� . L�S2 �� � ��-- �-- � Address J � s��' � -�� <�� -�-- Ciry r/ State Zip Phone I understand �y ri�hts as s ed above. // i' `' `'" �� <�' �' �`� _ Signature � -