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r Z Sec.13.04 RIGH'TS OF SUB.TECTS OF DATA Subd. I. Type of data. The righa of individual on whom the data is stored or[o be stored shall be as set forth ia this secdon. Subd.2. Information reqirired to be givm individual. A.n individual asked to suppiy private or confideaaal data concerning himself shall be informed of: (a)the pucpose and intended use of the requesred data wiehin the collecang tta[c agency,polidcal subdivision,or statewide rys[em; (b)wherher he may refuse oti is legalty requimd co suppty the requesced data;(c)any known coasequence arising from his supplying or refusing to suppty privace or coafidendai data;and(d)the idenary of ocher persoas or enriaes au[horized by stace or fedecal law to receive the data. This requirement s6a11 not apply when an individual is asked to supply invesdgadve data,pursuant to secdon 13.82,subdivision 5,to a law enforcement o�cec. The commissioner of re�enue mav place the noace rsauired under this subdivision in the individual income tax or nropertv tax refund instrucdons inscead of on ehose forms. Subd.3. Access to data by individual. Upon request to a responsibie authoriry,an individual shall be informed whether he is the subject of scoced data on individuals,and whecher it is class�ed as public,private or confidenaal. Upon his fur[her requesc,an individual who is the subjecc of stored private or public data on individuals shall be shown the data without any charge to him and;if he desires,shall be informed of the content and meaning of rhat data. After an individual has been shown the private data and informed of irs meaning,the data need not be disclosed to him for six manths thereafter unless a dispute or acdon pursuanc to chis secdon is pending or addidonal data on the individual 6as been collected or created. The responsible authority shall provide copies of the privau or public data upon cequesc by rhe individual subject of[he dara. The responsible au�oriry may require the requesdng person to pay the actual cosu of making,certifying,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,excluding Saturdays,Sundays and legal holidays,if immediau comptiance is not possible. If he cannot comply with the request wi[hin that time,he shall so inform the individual,and may have an addidonal five days wi[hin wluch to comply with the request,ezctuding Saturdays. Sundays and legal holidays. Subd.4. Procedure when data is not accurate or compiete. An individual may contest the accuracy or compieceness of pubiic or pri�ate data conceming himself. To exercise rhis right,an individual shall aodfy in wriring the responsible authoriry describing[he nature of the disagreement. The responsibie authoriry shall within 30 days either: (a)cornct[he data found to be inaccurnte or incomplec�and aaemp�to nodfy past recipienu of inaccurate oc incomptete data, including recipients named by[he individual;or(b)nodfy the individual thac he believes rhe data to be correct. Data in dispute shall be disclosed only if the individuai's statement of disagreement is included with the d'uclosed dara. The decerminadon of the responsible auchoriry may be appealed pursuant to the provisions of the adminisaarive procedure act relating to contesnd 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 furnish ceRain private or confidential information. You are notified that: i, 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 permit or license requires Council action to approve, some information may become public. $, You have certain riehts 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. �JQc/,`L� �f��r`a ,vi /✓� SLG[�/lr' G!S Fin� Middle Last 3 Z Z ��r��,�� "�tt-,�J Address �r,t�c� �'?� �S3�k7 76 3- �Z k- �1 �'1 Ciry State Zip Phone I understand my rights as stated above. /(�l./� Signacuro