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Sec.13.04 RIGHTS OF S[JBJECTS OF DATA � Subd. l. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set fortlt in this sec6on. Subd.2. Information required to be given individual. M individual asked w suPP�Y Private or confidential data concemiog himself shall be informed of: (a)the pucpose and intended use of the requested data withiir the collecting State agency,poliacal wbdivision,or statewide system; (b)whe[her he may refuse or is legalty cequired W supply the'requested data;(c)any known consequence arising frotn his supplying or refusupg[o3upply priva�e or confidential data;and(d)the idenary�'other peraons or endries aurhorized by state or fedecal law w receive the data,.This requitement shai� not apply when an individual is asked to suppty investigative data,pursuant ro section 13.82,subdivision 5,to a law eafo[eeuieat.-affieec. . The commissio�ur of revemu mav olace the nodce reauired under this subdivision in the individual income tax or�rooe�tv taa refund inst�ucdons mstead of on those forms. Subd.3. Access to data by ladividual. Upon request to a responsible aurhoriry,an individual shall be info�w6ether he is the subject of storcd Aata on individuals,and whether it is classitied as public, private or co�dendal. Upon his further request,an individual w6o is the subject , of storcd private or public data on individuats shall be shown che data wi[hout,any charge to him and, if 6e desires,shall be informed of the content and meaning of that data. After'an individual has been shown the private data and iaformed of its meaning,the data need noc be disclostd to him for six months thereafur unless a dispute or acdon pursvant to this secrion is pending or addidonal data on the iadividua!has ban coUecoed or created. The responsible authority shall pcov�e copies of the private or public data upon roquest by the individual subjxt of the data. T6e responu'ble authoriry may require the requesting person w pay the actual costs of making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possible,with any aquest made pursuant to this subdivision,or within five days of the date of the request,ezcluding Sadt�days,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with du request within that time,he shall so infotm the individual,and may have an addidonal five days within which to comply with the requesc,excluding Sadtrdays, Sundays and legal holidays. Subd.4. Procedure wlxn data is not accurate or complete. An individual may contesc the accuracy or completeness of public or private data conceming himself. To eaercise this right,an individual shall nodfy in wridng the responsible authoriry des�ribing the nadtre of dte disagreement. The responsible authority shall within 30 days either: (a)correct the dara found to be inaccurate or incomplete and auempt to notify past recipients of inaccurate or incomplete data,including rocipients named by the individual;or(b)nodfy the indi�•idual that he believes the data ro be comect. Data in dispute shall be diulosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedun act relaang 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 j 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 permit or license. 3. The information may be;;hazed with other local, state or federal agencies to the extent 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 (availabie upon request) to review private data on yourself. 6. Your full name is required to process this application or permit. ��n�(l�t lS G iZI�.l G �i.I�MAQ.K Firsc Middle �i : 103�o Vl�t�� t�� '� IoS Address ��ta P�.a< <E Mtic SS3� �lt q�l q49q C��Y State Zip Phone [ u r d my rights as st e ove . � Oyl mre