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�#< , Sec.13.04 RIGHTS OF SLJBJECTS OF DATA Subd. 1. Type of 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. Information required to be givea individual. An individual asked to supply private or co�dential data concerning himself shall be informed of: (a)the purpose and intended use of the requested data wi[hin the collecang'state agency, political subdivision,or statewide syseem; (b)whether he may refuse or is legally required to supply the requested dare;(c)any lrnown consequence arising from his supplying or refusing to supply private or confidential data;and(d)the idendry of other persons or endties authorized by state or federal law to receive the data. This requirement shail not apply when an individual is asked to supply investigadve data,pursuant to secaon 13.82, subdivision 5, to a law enforcement o�cer. The commissionec of revenue mav place the norice required under this subdivision in the individual income tax or propertv tax cefund instructions instead of on those fornts. Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of srored data on individuals, and whether it is classified as public, private or confidenrial. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data wi[hout 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 iu meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acdon pursuant to this section is pending or addidonal data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the actual coscs of making, cerrifying, and compiling the copies. The responsible authority shall comply immediately, if possible, with any request made pursuant to this 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 rime,he shall so inform the individual,and may have an additional five days within which to 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 accuracy or compieteness of public or private data concerning himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. 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 incomplete data, including recipients named by the individual; or(b)notify the individual that he believes the data to be correct. Data in dispute shal]be disclosed only if the individual's statement 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 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 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 shared with other local, state or federal agencies to the extent necessary to process the permit or license. 4. If your requested pernut 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. C c ��L� G L �� i� ��`� 3 z�� First� M ddle �t � ��'� �'�-�--�—� � _ _ Ad ress � / `��j,�� - �;,�'�: `� �' �� //�, _�/J/�� °Ci�, State Zip Phone 7 i I und my. ' ts as Stated ab �, �/��, � ' _, - �.--�� � � C C / �1��s �-__�__—_---�._ � L L� ' - S' nature