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� � Sec.13.04 RIGHTS OF SUBJECTS OF DaT,� Subd. 1. Type of data. The righ[s of individual on whom[he data is stored or�o be scored shall be as sec forth in this secaon. Subd.2. Informatio�required to be given individual_ An individual asked to supply private or confidenrial data concecning himseif shall be informed of: (a)the purpose and intended use of the requested data within the collecting"statE agency,poliacal subdivisio�,or statewide system; (b)whether he may refuse or is legally required ro supply[he requested data;(c)any known consequence arising from his supplying or refusing to supply privare or confidential data;and(d)the idenciry of other penons or enddes authorized by state or federal law to receive the data. This requiremenc shall not apply when an individual is asked to supply invesrieadve daa.pursuant ro section 13.82, subdivision 5, to a taw enforcement officer. The commissioner of re�enue mav ptace the norice r^^uired under this subdivision in the individual income tax or propertv tax refund instructions instead of on those forms. Subd. 3. Access to data br indi��idual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals, and whe[her it is classified as public,privace or confidenaal. 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 informed of the content and meaning of[hat data. After an individual has been shown the private data and informed of iu meaning, the dara need not be disclosed to him for six months thereafter unless a dispure or acrion punuan[to this secdon is pznding or additional data on the individuai 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 authoriry may require�he requesting person to pay the acrual costs of making, cenifying, and compiling the copies. The responsibte authoriry shall comply immediarely, if possible, with any request made pursuant to this subdivision, or within five days of the date of the request,excluding Saturdays,Sundays and leeal holidays,if immediate compliance is not possible. If he cannot comp(y with the request within that time,he shail so inform the individual,and may have an addiaonal five days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. I'rocedure when data is not accurate or complete. An individua!may contest thz accuracy or completeness of public or private data conceming himself. To exercise this rieht,an individual shall noafy in writing the responsible authori[y describing the na[ure of the disagreement. The responsible authoriry shall within 30 days either: (a)correct[he data found to be inaccurate or incomplete and attempt to nodfy past recipienu of inaccurate or incomplete data, including recipients named by [ha individual; or(b)notify the individual[ha[he believes the data to be correcc. Data in dispute shall be disclosed only if the individual's statement of disagreement is included wi[h the disclosed data. The determination of the responsib(e authoriry may bz appealed pursuant to the provisions of the admuustradve procedure act reladng to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "Riehts 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 permit or license. 3, The information may be shared with other local, state or federal agencies to the e�tent necessary to process the permit or license. 4. If your requested pemut 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 yourseif. 6, Your full name is required to process this application or permit. ' �.l2_ �,�`� , ` First �iiddle Last �� .�� /.�C� C'. r�r/l/O L� /�'C'� �ti Address ��? ��%�'- C ✓� %�� Ciry Stare Zip Phone I understand my rights as state above. /� '� i � �/�'� �'� ��l�� Si na[ure