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Sec.13.01 RIGHTS OF SUB.TECTS OF DATa Subd. 1. Tvpe of data. The rights of individual on whom the dara is stored or to be stored shall be as set forth in this section. Subd.2. Information reqtrired 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 agency, poliacal subdivision,or statewide system; (b)whether he may refuse or is legally required to supply the requested data:(c)any laiown consequence arising from his supplying or refusing to supply private or confidentiai data;and(d)the idenriry of other persons or enrities auchorized by state or federal law ro receive the data. This requirement shall not apply when an individual is asked to supply invesrieadve dara, punuant ro section 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav place the nodce reauired under this subdivision in the individual income tax or property tax refund instcuccions instead ot on those forms. Subd. 3. Access to data by individual. Upon request 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 confidendal. Upon his furthec request, an individual who is the subject of stored privace or public dara on individuals shall be s6own the data without any charge to hun and, if he desires, shall be informed of the content and meaning of[hat data. Afrzr an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six monchs thereafter unless a dispute or acaon pursuan[to this secrion is pending or addiaonal data on the individual has been collected or created. The responsible authoriry shall provide copies of che private or public data upon request by the individual subject of the data. The responsible authority may require the requesring person to pay the accual cosu of makin¢,certifying, and compiling the copies. The responsibte au[horiry shall comply immediately, if possible, with any request made pursuant to this subdivision, or within five days of the date of the reques[,excluding Saturdays,Sundays and legal holidays,if immedia[e compliance is not possible. If he cannot comply with the requesc within that time,he shall so inform[he individual,and may have an addidonal five days within which to comply wi[h 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[his right,an individual shall noafy in wriang the responsible authority describing the nature of the disagreemen[. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccunte or incomptete and attempt to nodfy past recipienu of inaccurate or incomplete data, including recipients named by che individual; or(b)notify the individual that he believes the data to be correct. Data in dispu[e shall be disclosed only if the individual's statemenc of disagreement is included with the disclosed data. The determinadon of the responsible au[horiry may be appealed pursuant ro the provisions of the administradve procedure act reladng to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "Ri�hts 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 pemut 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 ro 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. �. You have certain rights 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. !��' f�� tM p �TT l-t � c•� N O�1Z (J First Middle Last '�z �fo C�nJC.Q A-UE • Address S7 ��L �'�� "�%/� �� !- �3� � �z�S'. C�ry State Zip Phone r., � I und rsta�d my rights state,d above. - - '`-t - l,' Signacure