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`�i rT• Sec.13.04 RIGHTS OF SUBJECTS OF DaT� Subd. i. Type of data. The righrs of individual on whom[he data is stored or to be stored shall be as set forth in this secaon. Subd.2. Informatioa reqirired to be given individual. An individual asked to supply private or confidenrial data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting"state ageacy, polirical subdivision,or sratewide system; (b)whether he may cefUse oY is legally required to supply the requested data:(c)any Irnown consequence arising fmm his supplying or refusing to supp(y private or confidendai data;and(d)the idenary of o[her persons or enrides authorized by state or federal law to receive the data. This requirement stiall not apply when an individual is asked to supply invesdgaave dara, pursuant to section 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav place the noace reauired under this subdivision in the individual income tax or proper[v tax refund instructions ins[ead of on those forms. Subd. 3. Access to data by individual. Upon reques[to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals, and wherher it is classified as public, private or confidential. Upon 6is fucther request, an individual who is the subject of stored private or public data on individuals shall be shown the 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 its meaning,the data need not be disclosed to hirn for six months thereafter unless a dispute or action pursuant to this secdon is pending or addidonal data on the individual has been collected or created. 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 the requesting person to pay the acnial coscs of makine, certifying, and compiling the copies. The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision, or within five days of the date of the request,exc(uding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shail so infocm the individual,and may have an additional five days wirhin which to comply with the request,excluding Saturdays, Sundays and legal hotidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or pri��ate data concerning himself. To exercise this right,an individuat shall noafy in wriang the responsible authoriry describing[he nature of the disagreement. The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individual that he believes the data to be correct. Data in dispute shali be disclosed only if the individual's statement of disagreement is included with the disclosed data. Tlie determination of the rzsponsible authoriry may be appealed pursuant to the provisions of the administradve procedure act relacing to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "Rishts 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 detemune your qualification for the pemut 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 permit or license. 4. If your requested permi[ 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 yourself. 6. Your full name is required to process this application or permit. �\ � � ��1, -- ' � i'�� , i/ �`�� FiCst , vliddle Last : •—- � i �' y _ � _ ' i :'�. Addr�ss �/ --- . — / - ��, "� i,. i� 4 � .,'- ��: ,� �-��- -' - -- i� / . C�n, � State Zip Phone I understand my rights as stated above. �— _ � — 9ignature