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__ � � Sec.13.04 RIGHTS OF SLiB.TECTS OF DAT.a Subd. 1. Type of data. The righrs of individual on whom the data is stored or to be stored shall be as set forth in this secaon. , Subd.2. Information require�to be given individual. An individual asked to supply private or confidential data concerning himself sball be informed of: (a)the purpose and intended use of the requested data within the colleccing'state agency, polidcal subdivision,or statewide system; (b)whether he may refuse or is leeally required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply private or confidenoal data;and(d)the identiry of other persons or enaaes authorized by state or fede�al law[o receive the data. This requiremeat shall not apply when an individual is asked to supply investigative data, pursuant to secaon 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav place the norice required under�his subdivision in the individual income tax or propem tax_refund instrucdons instead of on[hose forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shalt be informed whether he is the subjec[ of stored data on individuals,and whether i[is classified as public, private or co�dential. Upon his further request, an individual who is the subject of stored private or public data on individuals shall be shown[he dara without any charge to him and, if he desires, shall be informed of the conten[ and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this secdon is pending or addirional data on the individual has been collected or created. The responsible authoriry shall provide copies of che private or pubtic data upon request by the individual subject of[he data. The responsible auchoriry may require the requesting person to pay [he actuai costs of making, cemfying, 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 Saturdays,Sundays and legal holidays,if immediate compliance is no[possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addirional five days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure�vhen data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himse(f. To exercise this right,an individual shall no[ify in writing the responsible authoriry describing the nature of the disagreemenc. The responsible authoriry shall within 30 days either: (a)correc[the data found to be inaccurate or incomplete and attempt to noafy past recipients of inaccurate or incomplete data, including recipienes named by the individual; or(b)notify the individuai that 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. T'ne determinadon of[he responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relating to contested 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 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 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 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. -�"G'�1�1 �_ h�,�/L'S�.'�YI - First tifiddle Lasc .�S�o�K�'c`�- l71 l�=.� ✓�,VUe� Address �PP��VIGr��K/ !�✓�A/ ��--�J/ Y7S-��-�� Ci�, State Z�p Phone I understand my rights as stated above. �� ` Signature