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� , ` Sec.13.Od R[GHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on�vhom the data is stored or to be stored shall be as set forth in this section. Subd.2 Information required to be given individual. An individual asked to supply private or confidential data concerning himselfshall be infonned of: (aj 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 supplyiiig or refusing to supply priva[e orconfidential d1ta;and(d)the identity ofother 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[o section 13.52,subdivision 5,to a law enforcement officer. The commissioner of revenue ma,�place the notice required under this subdivision in dte individual income tax or propert�ax 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 whether he is the subject of stored dafa on individuals,and whether it is dassitied as public,private or confidential. 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 content and meaning oti 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 sis months thereafter�miess a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authority shall provide copies of the private or puUlic data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual costs of making,certitying,and compil ing the copies. The responsible authority shall comply immediately,if possible,�vith any request made pursuant to this subdivision,or�vithin tive days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot compfy with the request within thaf time,he sltall so inform the individual,and may have an additional tive days within which to comply�vith the request,eacluding 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 this right,an individual shall notity in wTiting the responsible authority describing the nature ofthe disagreement. The responsible authority 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)notity the individual 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. The detennination of the responsible au[hority may be appealed pursuant to the provisions of the administrative procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. l 3.04,Subd.2,"Rights of subjects of data",we would like to inform you that your request for a pernlit 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 wil! be used to detennine your q��alific�tion for the permit or license requested. _. You may reiuse to supply data,but refusal may require tha.the City der�y the pern��;or licerse. 3. The information may be shared �vith other local, state or federal agencies to the extent necessary to process the perniit or license. 4. If your requested permit or license requires Council action to approve, some information may become public. 5. You have certain rights w�der 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. Eirst Niiddl � Last �� r-«�c� � ��C�1� �T�N��:,��n�� ,��,�,� Address J�;' �� / � � �,✓ /'�� ' �✓L� L , GJt,L � Lb�� ti �� Cit}��f (�, ��'�� Statc Zip Phonc �` �°�1 r� � � �; �:: �- �;�% �.. [ unde stand y r hts� tated above. �y � �� � ..�,r�;4i Si�naturc Reset rm 3?