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1 Y • Sec.13.04 RIGATS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Information required to be given indi�idual. An indi•.�3ua1 asked to supply private or confidential data concerning himseif shall be informed of: (a)the purpose and intended use of the requested data K-ithin the coliecting state agency,political subdivision,or statewide system;(b)whether he may refuse or is legally required to supply the reques:�d data; (c)any known consequence arising from his supplying or refusing ro supply private or confidential data;and(d)the idendry of other pzr,ons or entities authocized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply im estigative data, pursuant to section 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav alace the norice reauired ur�der rhis subdivision in the individual income tax or�rooertv tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a respensible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown t�z data without any charge to him and, if he desires,shall be informed of the content and meaning of that data. After an individual has been shou-n the private data and informed of its meaning,the data need not be disclosed to him for six mon[hs thereafrer unless a dispute or action pursuant tn this section is pending or additional data on the individual has been collecred or created. The responsible authoriry shall provide copies of the pm are or public data upon request by the individual subject of the data. The responsible au[hority may require the requesting person to pay the acn:a]costs of making,certifying,and compiling the copies. The responsible authoriry shall comply immediately,if possible,w i�any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holida�s, if immediate compliance is not possible. If he catuiot comply with the request within that time, he shall so inform the individual, and may ha�e 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 compieteness of public or private data concemutg himself. To exercise this right,an individual shall r:�rify in writing the responsible authoriry describing the nature of the disaereement. The responsible authoriry shall within 30 days either. (a)correcc the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,including recipients named b� the individual;or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's srat�ment of disagreement is included with the disclosed data. The determinarion of the responsible authority may be appealed pe:suant to the provisions of the administrative procedure act relating to contested cases. DATA PRIVACI" �DVISORY 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 an�- 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 ma�• require that che City deny the permit or license. 3. The information may be shared 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 (a��ailable upon request) to review private data on yourself. 6. Your full name is required to process this application or permit. K�15�'( � 31� ' �J- r\'1�2('S6r1 First Middle Last I�-f�e r��,, I� u �- �1c t�� Address �`` u.�� `�'l�. 5S3`�i �5�3 -y11-,�L-�� City State Zip Phone I understand my rights as stated above. �� :��t_� h .C�,_„-,<�._._; _�. Signature 6