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•f • Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The righu of individual on whom the data is stored or m be stored shall be as set forth in this secrion. Subd.2. Information required to be given individual. An individual asked to a:pply private or confidential data conceming himself shall be informed of: (a) the purpose and intended use of the requested data within the collecting:ate agency, political subdivision, or statewide s}��:m; (b) whether he may refuse or is legally required to supply the requested data; (c)any known ccr.wquence arising from his supplying or refusing rn supply private or confidenual data; and(d)the identiry of other persons or entities authorized by srac�or federal law to receive the data. This requirer�nt shall not apply when an individual is asked ro supply investigative data, pursuant to section 13.8'_. �ubdivision 5, to a law enforcement officer. The commissioner of ievenue may place the norice required under this subdivision in d:�individual income tax or property tax refund insavcrions instead of on those forms. Subd.3. Access to data by individuaL Upon request to a responsibie authoriry. aa individual shall be informed whether he is the sabject of stored dara on individuals,and whether it is classified as public,private or confidendaL Upon hi further request, an individual who is the subject ef scored private or public data on individuals shall be shown the data without any charge to him and. �he desires, shall be informed of the content and�aning of that data. After an individual has been shown the private data and informed of iu mea�as, the data need not be disclosed to him for sit months thereafrer unless a dispute or acdon pursuant to this section is pending or additional data on the individual has been collected or created. The res�onsible authority shall provide copies of the private or pubiic data upon request by the individual sut_:�t of the data. The responsible authoriry may r�ciire the requesting person to pay the actual costs of making, certifying, and compiling the copies. The responsible authority shall comp►y immediately, if possible, with any request s:de pursuant to this subdivision, or within five da�-s of the date of the cequest,excluding SaAirdays,Sundays and legal holidays, if immediate compliance is ao[possible. If he cannot comply with the reques within that time,he shall so inform the individual, and may have an additional five days within which:�comply with the request, excluding Saturdays. Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may ce�::st the accuracy or completeness of public or pri�-ate data conceming himself. To exercise this right, an individual shall notify in writing the responsib;�authoriry describing the nature of the disagreemrat The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or i�:emplete and attempt to notify past recipients of ir�ccunte or incomplete data,including recipients named by the individual; or(b)notify the individual�:st he believes the data to be correct. Data in dis�cte shall be disclosed only if the individual's statement of disagreement is included with the disclosed,'.ata. The determination of the responsible authority may be appealed pursuant to the provisie:s of the administrative procedure act relating to ccntested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", w�e would like to inform you that your raquest for a permit or license from the City of Orono or any of its department� may require you to furnish cenain pri�-ate or confidential information. You are notified that: 1. 'The information you fumish will be used to determine your qualification for the permit or license reqaested. 2. You may refuse to supply data, but refusal may require that the City deny the pernut or license. 3. The information may be shared with other local, state or federal agencies to the extent necessary ro process the permit or license. 4. If your requested permit or license requires Council action to a.�prove, 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. ��/C'�l%c.� �c'.�..-�1J f/�Y�� _ First � Middle Last ��11�s( ��vw/r�.o��c �r Address /� �3 /,�lv.s.�u.�,.�w h-c�J S S y� � �'i S-- "�/ City State Zip Phone I understand my rights as stated above. � Signa e 10