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. .. � Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is scored or to be stored shall be as set forth in this secdon. Subd.2. Information required to be given individual. An individual asked to supply private or confidendal data conceming himself shall be informed of: (a)the purpose and intended use of rhe requested data within the collecdng§tate agency,poGdcal subdivision,or stacewide system; (b)whether he may refuse or is legally required w supply the rcquested data;(c)any l�own consequence arising from his supplying or refusing to supply private or confidential data;and(d)the idendry of other persons or endaes authorized by state or federal law w receive the data. This requirement shall not apply when an individual is asked to supply invesdgaave data,pursuant to secdon 13.82,subdivision 5,to a taw enforcement officer. The commissioner of revenue mav place the notice required under this subdivision in the individual income tax or propertv tax refund insavcrions instead of on those forms. Subd.3. Access to data by indiridual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,privau or co�dendal. Upon his further request,an individual who is the subjecc of stored private or public data on individuais shall be shown rhe data wichout any charge to him and;if he desires, shall be informed of the concent and meaning of that data. Aher an individual has been shown the private data and informed of irs meaning,the data need not be disclosed to him for six months thereafter uniess a dispuce or action pursuant to this secdon is pending or addidonal data on the individuai has been collected or crea[ed. The responsible authority shali provide copies of the private or pubiic data upon roquesc by the individual subject of the dara. The responsible authoriry may require the requesting person to pay the acmal costs of making,cerdfying,and compiling the copies. The responsibie authoriry shall comply immediately,if possible,wi[h any request made pursuant to this subdivision,or within five days of the date of the roquest,ezcluding Saturdays,Sundays and legal holidays,if immedia[e compiiance is no[possible. If he cannoc comply with the reques� within that time,he shall so inform the individual,and may have an addidonal five days within which to comply with the requesc,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure whea data is not accurate or complete. An individual may contest the accuracy or compieteness of public or private data concerning hunself. To exercise this right,an individual shall noafy in writing the responsible authority describing the nature of the disagreement. The responsible authority shall within 30 days ei[her: (a)correct rhe data found[o be inac.curate or incomplete and attempt to norify past recipienrs of inaccurate or incomplete data, including recipiena named by the individual;or(b)nodfy the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's staumenc of disagreement is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relating to con[ested 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 pemut or license from the City 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. 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. r y � � Fi st idd Last f�'� 9 � 7 z. �� tl ,�) Add�1a �.� ��-�3 vy 7�3 --�aGG ��ry, State Zip Phone un rstand my ri ts as stated above. � Signa e