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� � f Sec.13.04 RIGH'TS OF SLJB.TECTS OF DATA Subd. 1. Type of data. The rights of individual on whom�he data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. ?.n individual asked to supply private or confide�rial data concerning himseif shall be informed of: (a)the purpose and intended use of the requested dan within the collecting"statE agency, polidcal subdivisiou,or sratewide system; (b)whether he may refuse oY is legaily required to supply the reques[ed data;(c)any known consequence arising from his supplying or refusing to supply • private or confidenrial data;and(d)the idenriry of other persoas or enaues auchorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesrieaave dara, pursuant to section 13.82, subdivision 5, to a(aw enforcement officer. The commissioner of re�enue mav place the notice required under this subdivision in the individual income tax or_propertv tax tefund instrucrions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whe[her he is the subject of stored data on individuals, and whe�her it is classified as public, private or confidenaal. Upon his further request,an individual who is the subjec[ of srored private or public data on individuals shall be shown the data wi�hout any charge to hirn and, if he desires, shall be informed of the concent and meaning of that data. After an individual has been shown[he privace data and informed of its meaning,ihe data need not be disclosed[o hiin for six months thereaTter unless a dispute or acrion pursuant to this secaon 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 individuai subject of the data. The responsible authoriry may require the requesting person to pay the actual costs of makine, certifying, and compiling the copies. The responsible authoriry shall comply immediate(y, if possible, wirh any request made pursuant to this subdivision, or within five days of the date of the request,excluding Saturdays,Sundays and 1e2a1 holidays,if immediate compliance is not possible. If he cannot comply with the request within thac time,he shall so inform the individual,and may.have an addidonal five days within which to comply with the request,excluding Saturdays, Sundays and legai holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or pm•a[e data conceming himself. To exercise this right,an individua(shall notify in wridng 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 incomplete and attempt to nodfy past recipienu of inaccurate or incomplete data, including recipiencs named by the individual; or(b)notify the individual that he believes the data to be corcect. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsibfe authoriry may be appealed pursuant to the provisions of the administradve procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "Ri;hts of subjects of data", we would like to inform you that your request for a pernut or license from the Ciry of Orono or any of its departments may require you to furnish certain private or confidential information. You are notified thar. 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 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. 5. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. (. Your full name is required to process this application or permit. Le��1 Ke,ne e �-�'�' - First vliddle Last 3�� Address �� >L�..�-, t��v ��3�l 4��i -�� ��, Stare Z�p Phone I understand my rights as stated above. � Signature