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� A � Szc.13.04 RIGHTS OF SUBJECTS OF D�TA Subd. 1. Type of data. The righa of individual on whom[he data is stored or to be stored shall be as set for[h in this secaon. Subd.2. Information req�red to be given individual. An individual asked to supp(y private or confidential data conceming himself chall be informed of: (a)[he purpose and in[ended use of the requested dara wi[hin the collecdng'state agency,polidcal subdivision,or sratewide sysum: (b)whecher he may refuse or is legally required to supply the requested data;(c)any�own coasequence arising from his supplying or refusing to supply priva[e or confidendal data:and(d)[he identiry of other pzrsons or entiaes auchorized by state or fedetal law to receive the data. This requirement shail not apply when an individual is asked to supply imesagaave dara, pursuan[to secrion 13.82, subdivision�, to a law enforcement officer. The commissioner or revenue mav olace �he nodce re uired under chis subdivision in the individual income tax or rooem taz refund insaucrions instead of on those forms. Subd. 3. �ccess to data by individual. Upon request to a responsible auchoriry,an individual shall be informed whecher he is the subject of stored data on individuals, and whecher i[is classified as public, private or contidenaal. Upon his further request, an individual who is the subject of stored private or public data on individuals shall be shown[he data wi[hout any charge to him and, if he desires, shall be iniormed of the content and meaning ot"that data. After an individual has been shown[he priva[e data and informed of its meaning,the dara need not be disclosed to him ior six monchs thereafter unless a dispute or action pursuan[to this secaon is pending or addiaonal dara on the individuai has been collected or crea[ed. The responsible authoriry shall provide copies of the priva[e or public data upon request by the individual subject of the data. The responsible auchoriry may require che requesting penon to pay the actual cosu of making, cerrifying, and compiling the copies. The responsible auchonty shall comply immediacely, if possible, with any request made pursuant[o this subdivision,or within five days oi the da[e of[he request, excluding Saturdays,Sundays and legal holidays,if immediate compiiance is not possible. If he cannot comply wich the request wi[hin that time,he shall so inform the individual,and may have an addidonal five days wichin which to comply wi[h the request,excluding Saturdays, Sundays and lega!holidays. Subd.4. Procedure when data is not accurate or complete. An individual may con[esc the accuracy or completeness of public or private data concerning himself. To exercise[his nght,an individual shall nocify in writing[he responsible authority describing the nature of the disagreemenc. The responsible au[horiry shall wichin 30 days either: (a)correct rhe data found to be inaccurate or incomptece and attemp[to nodfy pasc recipiena of inaccura[e or incomptete data, including recipienes named by the individual; or(b) nodfy the individual tha[he beiieves the data to be correct. Data in dispute shall be disclosed only if the individual's statemen[of disagreement is included wi[h the disclosed data. The de[erminanon of the responsible authonry may be appealed pursuan[ro the provisions of the administrative procedure ac[ reladng co contested 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 departmen[s may require you to furnish certain private or confidential information. You are no[ified that: 1. The information you furnish will be used to determine your qualification for the permit or license requested. 2, You may refuse ro supply data, but refusal may require that the Ciry deny the pemut or license. 3. The information may be shared with other local, state or federal agencies to rhe extent necessary to process the permit or license. 4. If your requested permit or license requires Council action to approve, some infocmation may become public. j. You have cenain rights under 'v1.S. 13.04 (available upon request) to review private data on yourself. (, Your full name is required to process this application or permit. � �� ',c_ ��`� �- ��,1-.-�KZ � r �� S� �� ` �"L Firs[ � `liddle La �� Address � �j� C;�� 1 1 � — � � v c� ^ C City Sta�e Zip Phone � I understand my rights as sta ab e. — !' l I � � 5ignamre �� �