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. . • . Sec.13.04 RIGHTS OF SLJBJECTS 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 secaon. Subd.2. Information required to be given individual. An individual asked ro suppiy private or confidential data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b)whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidendal dara;and(d)the idenary of other persons or entities authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data, pursuant to section 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav olace the norice reauired under this subdivision in the individual income tax or orooertv tax refund instruction� instead of on those forms. Subd, 3. Access to data by indi�•idua;. C'ror.reques[co a re:pr,r.s:rde autt�oriry,an i.-.divi�'..::i!sh:i'1 be iniormed whether he is thz s�bject of stored data on individuals, and whe;her it;s classiiied as publi.:. pri�atr or cor.fi�ential. lipon his further request,an individual who is the subject of stored private or public da�a on individuals shall be shuwn t}�e data without any charge to him and, if he desires, shall be informed of the conter.[and meaning of that data. Afrer an individual has been shown the private da�a and informed of its meaning,thz data need not be duclosed to him for six munths thzreaher unless a dispute or action pursusnt to this section is per.ding or additional data on the individual has been cd:::cted or created. The responsibfe authority shall provide copies of thz private or public daca upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actuaf costs of makin�,cettitying, and compiling the copies. The responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or wi[hin five days of the date of the request, excluding Saturdays,Sundays and legal holidays, if immediatz compliance is not possible. If he cannot comply with the request within[hat time, he shall so inform the individual, and may have 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 completeness of public or private data conceming himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. The tesponsible authority shall within 30 days either. (a)correct the dara found to be inaccurate or incompiete and attempt to notify past recipients of inaccurare or incomplete data,includin�recipients named by the individual;or(b)notify the individual that he believes the data ro be correct. Data in dispute shall be disclosed only if the individual's statement of disa,reement is included with the discloszd data. The determinacion of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relatin� to contested cases. D�TA PRIVACY ADVISORY 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 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 permit or license requested. 2. You may refuse to supply data, but refusal may require that the Ciry 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 permi[or license. 4. If your requested permi[or license requires Council action ro 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 chis application or permit. �_ �r+-� ��5 First Q Midd] Last lo�v /V U ra.�ti ►�ca.�- Address � - - 3 Ciry 3tate Zip hone I understand my rights as ted above. Sionature 6