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ti� �. Sec.13.04 RIGHTS OF S[1B.TECTS OF DAT?� Subd. i. Type of data. The righrs of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himseif shall be informed of: (a) the purpose and intended use of the requested data wichin the colleccing"state agency, political subdivision, or statewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any I:nown consequence arising from his supplying or refusing to supply private or confidenrial data;and(d)the idenrity of o[her persons or enaries authorized by sta[e or federal law to receive the data. This requiremenc shall not apply when an individual is asked to supply invesdeaave data, pursuant to section 13.82, subdivision�, to a law enforcement officer. The commissioner of re�enue mav place the noace reauired under this subdivision in the individual income tax or propertv tax refund instcuc[ions instead of on[hose forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whe[her he is the subjecc of stored data on individuais, and whecher it is ciassified as public, private or confidendal. Upon his further requesc, an individual who is the subject of stored private or public data on individuals shall be shown the data wi[hout any charge to him and, if he desires, shall be informed of ihe content and meaning of[hat data. After an individual has been shown the private data and informed of its meaning,che data need not be disclosed to hun for six months thereafter unless a dispute or acrion pursuan[to this section is pending or addiaonal data on the individual has been collected or crea[ed. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require che requesting person to pay [he actual costs of makine, 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 reques�,excluding Sa�urdays,Sundays and leeal holidays,if immediate compliance is noc possible. If he cannoc 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 privare data concerning himself. To exercise this rieht,an individual shall noafy in writing the responsible authoriry describing[he na[ure of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to norify past recipiencs 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 disclosed only if the individual's statement of disagreement is included with[he disclosed data. The determinadon of the responsible authoriry may be appealed pursuant to the provisions of the administnrive procedure act reladn; to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Ri�ts 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 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 pernut or license. 4. If your requested permit or license requires Council ac[ion 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. c-- � �—. _ ,-�. ��; L� ��i �� .)�_ �L�-\ T— ��C= � First ,�(� �tiddle Last ��L--� j. x C� c="--l__ `t�-� - Address �' ��'� U y�CJ l�.e� �''L�t`� �� ' e-J �7 �� •- .l Z / C�ty State Zip Phone I understand my ri?hts as stared ab e. C —__ � <�i��,� Signa[ure