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.� � Sec.13.04 RIGHTS OF S[JB.TECTS OF DAT� Subd. 1. Type of data. The righrs of individual on whom the data is stored or to be scored shall be as set forth in this section. Subd. '_. Information reqirired to be given individual. An individual asked ro supply private or confidendal data conceming himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting'state agency, poliucal subdivision,or sratewide system; (b)whether he may refuse oi is legally required to supply the requested data:(c)any Irnown consequence arising from his supplying or refusing to suppiy priva[e or confidenaal data;and(d)the iden[iry of other persons or enaaes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investieadve dara, pursuanc ro secdon 13.82, subdivision 5, to a law enforcemenc o�cer. The commissioner of re�enue mav place the nonce reauired under this subdivision in the individual_income tax or propem tax refund instructions instezd of on those forms. Subd. 3. Access to data b�indi�ldual. Upon reques[to a responsible authority,an individual shali be informed whe[her he is the subject of stored data on individuals, and whether it is classified as public, private or confidenaal. Upon his further request, an individual who is the subject of stored private or public data on individuals shall be shown the data wichout any charge to hun and, if he desires, shall be informed of the content and meaning of[hat data. After an indi•+idual 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 acrion pursuan[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 individual subject of[he data. The responsible authority may require the requesting person to pay the accual costs of making, certifying,and compiling the copies. The responsibie 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 immediate compliance is not possible. If he cannot comply with the request wi[hin that time,he shall so inform the individual,and may have an addi[ional five days within which to comply wi[h the request,exc!uding 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 himself. To exercise this rieht,an individual shall norify in wricing the responsible authori[y describing[he nature of the disagreement. The responsibfe authoriry shall within 30 days either. (a)correct the data found ro be inaccurate or incomplete and attempc to nodfy past recipienu of inaccurate or incomplete data, including recipients named by che individual;or(b)noufy the individual tha[he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. Ttie de[erminadon 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, "Ri;hts 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 i[s departments may require you to furnish 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 pemut or license. 4. If your requested permit or license requires Council action to approve, some information may become public. 5, You have cenain rights under M.S. 13.04 (available upon request) to review private data on yourself. (, Your fuil name is required to process this application or permit. n7��.�-� � r� `/�� e First :�iiddle Last 3 �� S � v f` � -e �: Address ��,,7 ��'✓ �_� �� / C)� — ��'� � vP J�-� v C�ry State Zip Phone I understand my rights as stated above. � � .�'-� ` � v Signa[ure