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� Sec.13.04 RIGHTS OF SIJBJ�CTS OF DATA Subd. 1. Type of data. The righ[s of individual on whom the data is stored or co be stored shall be as set forth in this secdon. Subd.2. Information required to be given individual. An individual asked to suppiy private or confidential data conceming himself shall be informed of: (a)the pucpose aad intended use of the requested dara within the collecdng 3tate agency,polidcal subdivision,or statewide system; (b)whether he may refuse or is legaily required to supply the requested data;(c)any Imown consequence arising from his supplying or refusing to supply private or confidential data;and(d)rhe idendry of other persons or endries authorized by state or federal law to receive the data. This requirement shall not apply when an individuai is asked to supply invesdgadve dara, punuant[o secdon 13.82, subdivision 5, [o a law enforcement officer. The commissioner of revenue mav �lace the nodce required under this subdivision in the individual income tax or prooertv tax refund instrucrions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whecher it is classified as public,private or confidendal. Upon his further request,an individual who is the subject of stored private or public dara on individuals shall be shown che data wichout any charge to him and,�if he desires, shall be informed of the contenc and meaning of that data. Aher an individual 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 acdon pursuant to this section is pending or addidonal dara on the individual has been co(lected or crea�ed. The responsible authoriry shall provide copies of the private or pubiic data upon request by the individual subject of the data. T'he responsible aurhoriry may require[he requesting person to pay the actual costs of making,certifying,and compiling the copies. The respoasible authoriry shall comply immedia[ely,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 requesc within that time,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or compiete. An individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shall nodfy in writing the responsible authority describing the nature of the disagreement. The responsibie authority shall within 30 days either: (a)correc[the data found w be inaccurate or incomplete and attempt to noafy past recipients of inaccurate or incomplete data,inciuding recipients named by the individual;or(b)nodfy the individual that he believes the dara to be correct. Data in dispute shall be disclosed only if the individual's statemenc of disagreement is included with the disclosed data. The detercnination 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, "Rights of subjects of data", we would 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 furnish certain private or confidential information. You are notified that: 1. The information you fumish will be used to determine your qualification for the pemut 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 shazed with other local, state or federal agencies to the eztent necessary to process the permit or license. 4. If your requested permit or license requires Council action 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. wr Ir�►R-�^ ��-C �'J �-?��58r✓ Fint Middle Last J��7�- /��s�`N �9��- �w Address • �'�C/C. f21(J G� �J N - J�� C��, State Zip Phone I under and my rights as stated above. Si nature