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� Sec.13.04 RIGHTS OF S'IJB.TECTS OF DATA Subd. 1. Type of data. The righcs of individual on whom[he data is stored or to be stored shall be as sec forth in this secdon. Subd.2. Information req�rired to be given individual. An individual asked to supply private or co�denaal data concerning himself shall be informed of: (a) the purpose and in[ended use of the reques[ed data within the coilecting'state ageocy,poliacal subdivision,or statewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any lrnown consequence arising from his supplying or refusing to supply priva[e or confidenrial data;and(d)the idenricy of other penons or enrides auchorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to suppiv invesa¢adve dara, pursuant to section 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of re�enue mav place the noace reauired under this subdivision in the individual income tax or propem tax refund instructions 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 whether it is classiFied as public, priva[e or confidenaal. Upon his further requesc, an individual who is the subject of stored private or public data on individuals shall be shown the data withouc any charge to him and, if he desires, shall be informed of the content and meaning of[hat data. Afrer an individual has been shown[he private data and informed of its meaning, the data need not be disclosed to him for six months thereafter unless a dispute or acdon pursuan[to this secaon is pending or addidonal data on the individual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible auchoriry may require the requesting person to pay the accual cosu of making, certifying, and compiling the copies. The responsible authoriry shall comply immediately, if possible, wi[h any request made pursuant to this subdivision,or within five days of the date of the request,exctuding Saturdays,Sundays and legal holidays,if immediate compliance is no[possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data conceming himself. To exercise this rieht,an individual shall nodfy in writing the responsible au[horiry describing the nature of the disagreement. The responsible authoriry shall within 30 days either. (a)correct the data found ro be inaccunte or incomplere and attempt to nodfy past recipienu of inaccucate or incomplete data, including recipients named by the individual; or(b)notify the individual thac he believes the data to be correct. Data in dispute shall be disclosed only if the individual's stacement of disagreement is included with che disciosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act relad�g 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 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 pemut or license. 3, The information may be shared with other local, state or federal agencies to the extent necessary to process the pernut or license. 4. If your requested permit or license requires Council action to approve, some informa[ion may become public. 5, You have certain ri�hts under M.S. 13.04 (available upon request) to review private data on yourself. (, Your full name is required to process this application or permit. � J rvtAt�-r,n� �� h Firs - f Middle Last l6 N ° AddG�y� ,,�,,J �r�22 �9�•h 3��- C�� State Zip Phone I understand my rights as stated above. ��,''(/L .�� Signature