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. � � � Sec.13.04 RIGHTS OF SLTB.TECTS OF DAT,� ' � Subd. 1. Type of data. The righu of individual on whom che data is stored or to be scored shall be as set forch in this secrion. Subd.2. Information reqirired to be given individual. ?.n individual asked to supp�y private or confidenaal data concerning himself sha11 be infotmed of: (a) the purpose and intended use of the requested dara wi[hin che collecdng'state agency, poliacal subdivision,or sracewide system; (b)whether he may refuse or is legally required to supply[he requested data;(c)any l�own consequence arising from his supplying or refusing to supply priva[e or conndendal data;and(d)the identiry of other penons or enriries authorized by state or federal law to receive the data. This requitement shall no�apply when an individual is asked to supply invesagaave dara, pursuant to secuon 13.82, subdivision�, to a law enforcement officer. 'Ilie commissioner of revenue mav lace the norice re uired under this subdivision in the individual income tax or ro�em rax refund inscrucnons instead of on those forms. Subd. 3. �.ccess to data by individual. Upon request to a responsible authoriry,an individual shall be informed whe�her he is che subject of stored data on individuals, and whether it is c(assified as public, priva[e or confidendal. Upon his fur[her request, an individual who is the subject of stored private or public data on individuals shall be shown[he data wichout any charge to hun and, if he desires, shall be informed of the conten[ and meaning of that data. .4frer an individuai has been shown the private data and informed of ics meaning,the data nzed not be disclosed to him for six months thereafter unless a dispute or action pucsuant to this secnon is pending or addidonal data on the individual has been collecced or creared. The responsible au[honty shall provide copies of the priva[e or public data upon request by the individual subject of the data. The responsible authoriry may require [he requescing person to pay the accual costs of making, cer[ifying, and compiling the copies. The responsible authoriry shall comply immediatety, if possible, with any requesc made pursuant to this subdivision, or wichin five days of the date of the request,excluding Saturdays,Sundays and legal holidays, if immediace compliance is not possible. If he cannot comply wi[h che requesc wichin thac ame,he shall so inform[he individual,and may have an addidonal five days wi[hin which to comply with[he request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or compiete. An individuai may contes[the accuracy or comp(eteness of public or private data concerning himself. To exercise this right,an individual shall nocify in wridng the responsible au�horiry describing the nature of the disagreement. The responsible au[horiry shall within 30 days ei[her: (a)correcc the data found to be inaccurate or incomplete and attempc to noafy past recipien[s of inaccurare or incomplete data, including recipients named by the individual; or(b)notify the individual tha[he be(ieves[he data to be correct. Data in dispu[e shall be disclosed only if the individual's sta[ement of disagreement is included with the disctosed data. The de[erminadon of che responsible au[hority may be appealed pursuan[to the provisions of the administraave procedure act relacing to concested cases. DAT� PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data", we wouid like to inform you that your request for a pernut or license from the City of Orono or any of its departments may require you to fumish cenain private or confidential information. You are notified that: 1, The information you furnish will be used to deternune your qualification for the permit or license requested. ?. You may refuse to suppiy data, but refusal may require that the City deny the permit or license. 3, The information may be shared with ocher local, state or federal a�encies to the extent necessary to process the permit or license. 4. If your requested pernuc or license requires Council action to approve, some information may become public. �. You have certain ri�hts under M.S. 13.04 (available upon requesc) to review private data on yourself. 6, Your full name is required to process this application or permit. � � � L � �, v� �tiddle ^ Las[ Fics[ `J; � Address �i ,� �`r�_/�_ ��l �� �� State Zip Phone City I understand my rights as tated above. / . ( i Signature �