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— � .. Z � Sec.13.04 RIGH'I'S OF SUBJECTS OF DaTA Subd. 1. Type of data. The rights of individual on whom tbe data is stored or to be scored shall be as set fonh in this secaon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal data conceming himself shall be informed of: (a)the purpose and in[ended use of the requested data within the collecting'stace agency, polidcal subdivision,or statewide rystem; (b)whether he may refuse or is legaliy required to supply the requested data;(c)any lmown coasequence arising from his supplying or refusing to supply • private or confidendal dara;and(d)the idenriry of other persoas or enades authorized by stace or federal law to receive the data. This requ'uemenc shall not apply when an individual is asked to supply invesrieaave dara, pursuanc to secuon 13.8?, subdivision 5, to a law enforcemenc ofFcer. - The commissioner of revenu� mav place che noace reauired under this subdivision in the individual income tax or propem tax refund instrucrions insread 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 scored data on individuals,and whether ic is class�ed as public, privace or confidendal. Upon his further requesc, an individual who is the subject of stored private or public data on individuals shall be shown che data wichout any charge to him and, if he desires, shall be informed of the concent and meaning of[hat data. Afrer an individual has been shown rhe private data and informed of i�s meaning, the data need not be disclosed to him for six months thereafter uniess a dispute or action pursuant to [his secaon is pznding or addiaonal data on the individual has been collected or creatPd. The responsible authoriry shall provide copies of the private or public data upon request by[he individual subjecc of the data. The responsible authoriry may require the requesting person to pay the actual costs of making, cerafying, and compiling the copies. The responsible authoriry shall comply immediacety, if possible, wich any request made pursuant to this subdivision, or within five days of the date of[he request,excluding Saturdays,Sundays and legal holidays,if immediace compliance is noc possible. If he cannot compfy with the request within[hat time,he shall so inform the individual,and may have an addiaonal 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 thz accuracy or completeness of public or private data conceming himself. To exercise[his right,an individual shall noafy in wriang che responsible authoriry describing[he nature of the disagreement. The responsible auchoriry shall within 30 days either: (a)correcc the data found to be inaccurate or incomplete and attempt to nodfy past recipien�s of inaccurate or incomplete data, including recipienLs named by the individual; or(b) notify the individual that he believes rhe data to be correct. Data in dispute shali be disclosed only if the individual's statemenc of disagreemenc is included with the disclosed data. The determinarion of the responsibte authoriry may be appeated pursuanc to the provisions of the administraave procedure act relaang to conrested 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 furnish 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 a;encies to the extent necessary to process the pernut or license. 4. If your requested permit or license requires Council action to approve, some informa[ion may become public. 5. You have certain rights under M.S. 13.04 (available upon request) to review priva[e data on yourself. 6. Your full name is required to process this applica�ion or permic. .( -�� G- Uf�� - Firs[ �tiddle Last Address _ Ciry State Zip Phone I understand my rights as stated above. Signature