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� . � Sec.13.04 RIGHTS OF S[JBJECTS OF DATa 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 secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidential data concerning himself shall be informed of: (a)the purpose and inteoded use of the requested data within the collecdng'state agency,polirical subdivision,or statewide system; (b)whether he may refuse oY is legaily required to supply the requested data;(c)any known coasequence arising from his supplying or refusing to supply private or confidendal data;and(d)the idendry of other persoas or enrides authorized by sute or federal law to receive the data. Ttus requirement shall not apply when an individual is asked to supply invesrigadve dara, pursuant to secrion 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of revenue mav Dlace the nodce reouired under this subdivision in the individual income tax or propertv tax refund instnicrions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public, private or co�denrial. Upon his further request,an individual who is the subject of stored private or public dara on individuals shall be shown the data wi[hout any charge to him and,'if he desires,shall be informed of the content and meaning of[hat data. After an individual has been shown che private data and informed of its meaning,the dara need not be disclosed to hun for six months thereafter unless a dispute or acrion pursuanc to this secdon is pending or addidonal da[a on the individual 6as been collected or created. The responsible authoriry shall provide copies of the private or public dara upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual costs of making, cerafying,and compiling the copies. The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision,or wichin five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is noc possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addidonal five days within wtuch 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 che accuncy or completeness of public or private data concerning himself. To exercise this right,an individual shall nodfy in writing the respoasible authoriry describing the naeure of the disagreement. The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of inaccurate or incomplete data, inciuding recipients named by the individual; or(b)nodfy the individual thac he believes the daca to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determinadon of the responsib(e authoriry may be appealed pursuant to the provisions of the adminisaadve procedure act reladng 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 pemut or license from the Ciry 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 perm.it or license. 3. The information may be shared wich 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. R,�V�/' �`l 11 /1/�i� �j��K�'�` - in� Middle Last �; �- �., � � SCT� �'G� � !�'� l ll� '% /� /' ..�. `�C � c Address �� '� 7=� rr�/i% �� yi- 9 7� r �� ;?�� 9��.�` Ciry State Zip Phone I understand my rights as stated above. _I. Signature / _