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� � Sec.13.04 RIGHTS OF SiJB.TECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or ro be stored shall be as set forth in this secrion. Subd.2. Information required to be given indiridual. An individual asked to supply private or confidendal data concerning himself shall be informed of: (a)the purpose and in[ended use of the requesced data within the collecting'state agency,political subdivision,or statewide system; (b)whether he may refuse or is legally required[o supply the requested data;(c)any known consequence arising from his supplying or refusing to suppiy private or conFidendal data;and(d)the idenary of other persons or enades authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigarive data, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav piace the norice required under this subdivision in the individual income tax or propertY tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or confidendal. Upon his fur[her request,an individual who is the subject of stored private or public data on individuals shal(be shown che 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 need not be disclosed to him for six months thereafter unless a dispute or acaon pursuant to this section is pending or additional 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 the data. The responsible authoriry may require the requesting person to pay the actual costs of making, certifyine, and compiling the copies. The responsible authoriry 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 possible. If he cannot comply with the request within that time,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 completeness of public or private data conceming himseff. To exercise this right,an individual shall noafy in writing the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomp(ete 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 shall be disciosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the admicustrative 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 pernut 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 detemune 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 pemut 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. �-<'t=�c' � �'`'_Y"?`�'_ ��s� First Middle Last '�` �c1 �'' v ��<_� — Address ��_G y < <:�-�-- (',7��; >; '�=-�� i� -�; 7 �-�� Cin, State Zip Phone I understand my rights as stated above. ��' �-��_ Signature`"