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' .�, � . � Sec.13.04 RIGFTTS OF S[TB.fECTS OF DATA Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information reqiared to be given individual. An individual asked to supply private or confidendal data concerning himself shall be informed of: (a)the purpose and inunded use of the requested data withia the collecting ttate agency,poliacal subdivision,or statewide rysum; (b)whether he may refuse oY is legally required to supply the requesud data;(c)any Imown consequence arising from his supplying or refusing to supply private or confidential data;and(d)the idendry of other persons or enades authorized by state or fedecal law to receive the data. T6is requirement s6all not apply when an individual is asked to supply invesdgadve data,pursuant to secdon 13.82,subdivision 5,to a law enforcement o�cer. The commissioner of re�enue mav place the nodce rewired under this subdivision in the individual income taz or propertY tax cefund instcuctions inscead of on[hose forms. Subd.3. Access to data by individuai. Upon request to a responsible aurhoriry,an individual shall be infocmed whether he is the subject of stored data on individuals,and whe[her it is classified as pubtic,private or confidendal. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data wirhout any charge to him and,-if he desires,shall be informed of the content and meaning of chat data. Afrer an individual has been shown the private data and informed of iu meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acdon pursuant to this secdon is pending or addidonal data on the individual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of che data. The responsible authoriry may require the requesdng person to pay the actual costs of making,certifying,and compiling the copies. The responsible au[horiry shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of the request,exciuding Saturdays,Sundays and legal holidays,if immediate compliance is not possibie. If he cannot comply with the requesc within that time,he shall so inform the individual,and may have an addirional five days within which W 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 accurecy or completeness of public or private dara conceming himself. To exerciu this right,an individual shall nodfy in wricing the responsible authoriry describing�he nature of the disagreement. The responsible authoricy shall within 30 days either: (a)correct the data found to be inaccurau or incomplete and attempt to noafy past recipients of inaccurate or incompiete data, including recipiencs named by the individual;or(b)notify the individual thac he believes the dara to be correcc. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determinadon of the responsible au[hority may be appealed pursuant to the provisions of the administrarive 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 fumish 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 shared with other local, state or federal agencies to the extent necessary to process the permit or license. 4. If your requesied 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 ihis application or permit. �c�5oa� (,'� • Urd�l� First iddle �t � • Ad V On a, ti l/ � � �l� - City State Zip Phone. I understand my ' ated above. Signamre