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� Sec.13.04 RIGHTS OF SLJBJECTS OF D�TA Subd. 1. Type of data. 'Ihe righcs of individual on whom the data is stored or to be stored shall be as set forth in this secrion. Subd.2. Information req�rired to be given indiridual. An individual asked to supply private or confidenaal data conceming himself shall be informed of: (a)the purpose and intended use of[he requested data within the collecang'state ageocy, po(itical subdivision,or statewide rystem; (b)whether he may refuse oY is legally required to supply[he requested data;(c)any f:nown consequence arising from his supplying or refusing to supply private or confidenrial data;and(d)the iden[ity of o[her persons or endries auchorized by state or federal law to receive the data. This requiremenc shall not apply when an individual is asked to supply invesneadve dara, pursuanc ro secdon 13.82, subdivision 5, ro a(aw enforcement officer. 'I'he commissioner of re�enue mav place the norice reauired under this subdivision in the individual income tax or propertv tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whe[her he is the subject of stored data on individuals, and wherher it is classified as public, private or confidenaal. Upon his further request, an individual who is the subject of stored private or public data on individuals shall be shown the data without any charge to him and, if he desires, shall be informed of the concent and meaning of rhat data. Afrer an individual has been shown che private data and informed of its meaning,the data need not be disclosed to hun for six months thereafter unless a dispute or acrion pursuant to [his secaon is pending or addidonal data on the individual has been collected or created. The responsibie au[horiry shall provide copies of the private or public data upon request by che individual subject of the data. The responsible authority may require the requesting person to pay the actual costs of makine, cerdfying,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,excluding Sanirdays,Sundays and legal holidays,if immediate compliance is noc possible. If he cannot comply with the request within that time,he shall so inform[he individual,and may have an addidonal 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 pm•ate data concerning himself. To exercise this rieht,an individuai shall notify in writing the responsibie authoriry describing the 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 notify past recipients of inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individual tha[he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the administraRve 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 to the extent necessary to process the pemut 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 (available upon request) to review private data on yourself. (. Your full name is required to process this application or permit. ��2�� e w1 � �v�. e��v - First � Ivtiddle Last .�� vr I cz� � Address � � � � � � l, �1 '� � `j L City State Zip Phone I unders d my rights as stated above. Signature