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� � Sec.13.04 RIGHTS OF SL'BJECTS OF D:�T?. Subd. 1. Type of data. The riehcs of individual on whom[he data is stored or to be stored shall be as sec forth in this secdoa. Subd.2. Information reqtirired to be given individual. An individual asked to supply privace or confidendal dara conceming himself shall be informed of: (a)the purpose and inrended use of the requested dara within the collecang'stat�ageocy, polirical subdivision,or scatewide rystem; (b)whecher he may refuse or is legally required�o supply[he requested data;(c)any 1a�town coasequence arising from his supplying or refusing to suppty • private or conFdenoal data;and(d)�he idenacy of other persoas or enodes auchorized by state or federal law to receive the da�a. This tequiremeot shall no[apply whzn an individual is asked co suoply invesdeadve dam, pursuant co secdon 13.82, subdivision 5, to a law enforcemenc o�cer. - Tha commissior r of revenue mav olace the norice r�ouired under this subdivision in the individuai income tax or prooem tax refund inscrucrions insczad of on thase forms. Subd. 3. Access to data by individual. Upon request to a responsibie authoriry,an individual shall be informed whecher he is the subject of stored data on individuals,and whecher it is classified as public, private or conftdenrial. Upon his furcher request, an individual who is the subjecc of scored privace or public data on individuals shall be shown the dara wi�houc any charge to him and,-if he desires, shall be informed of the contenc and meaning of chat data. After an individual has been shown the privace data and informed of ics meaning,tbe data need not be disclosed to him for six monchs chereafcer unless a dispute or acaon pursuanc to chis secdon is ptnding or addirional data on the individual has been collecced or created. The�esponsible auchoriry shall provide copies of the priva[e or public data upon requesc by�he individual subjecc of che data. The responsible authoriry may require the requesting person to pay che accuai cos�s of making, certifying,and compiling the copies. The responsible authoriry shall conply immediately, if possible, wich any request made pursuant to this subdivision,or wi�hin five days of the date of the request,exciuding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within[hac tirne,he shall so inform�he individual,and may have an addirional five days within which to comply wich the request,exctuding 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 concerning himself. To exercise chis rieht,an individual shall noafy in wricing che responsible authoriry describing the nacure of the disagreement. The responsible auchoriry shall within 30 days either. (a)correcc che da�a found to be inaccurate or incomplece and attempc to nodfy past recipiencs of inaccurate or incomptete data, including recipiencs named by the individual; or(b)nocify the individual[hat he believes the data to be correct. Data in dispute shall be disclosed only if the individual's sta�ement of disagreement is included with the disclosed data. The deczrminarion of the responsibte authoriry may be appealed pursuant[o the provisions of the adminisezarive procedure act relaring to conresced cases. DATA 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 pernut or license from the City of Orono or any of its departments may require you to furnish certain p:ivate or confidential information. You are notified that: � 1. The information you furnish wili be used to determine your qualification for the permit or license requested. 2. You may refuse to supply data, bu� 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 permit or license. 4. If your requested permit or license requires Council ac[ion to approve, some information may become public. 5. You have certain riQhts 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. �C�S ,� ��,L-Zlc.,�''l/ First �Siddle Lasc ,G�� iv�Y��-- ,F3 L v� Address �,/, ss-3GS ��'l�s� !f7"1LOt- `� _ Ciry Srate Zip Phone I understand my rights as stated above. ___—�__ �------� - Signacure