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< `. Sec.13.04 RIGHTS OF SUB.TECTS OF D�1TA Subd. i. Type of data. The righrs of individual on whom the data is stored or to be stored s6all be as set forth in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to suppiy private or confidenrial data conceming hitnself shall be informed of: (a)the purpose and iatended use of the requested data within the collecting'state agency,political subdivision,or statewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any lrnown co�sequence arising fmm his supplying or refusing to supply private or confidendal data;and(d)the identiry of ocher persons or enrides au[horized by state or federal law to receive the data. This requirement shall not appiy when an individual is asked to suppty invesrigadve data, pursuan[ro secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav place the norice reauired under this subdivision in the individual income tax or propertv tax refund instructions 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 whe[her it is classified 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 wi[hout any charge to him and, if he desires, shall be informed of the content and meaning of that data. Afrer an individual has been shown the privace data and informed of ia meaning,the dara need not be disciosed to him for six months thereafter unless a dispute or acdon pursuant to this secrion is pending or addidonal data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the acrual costs of making, certifying,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 not possible. ff he cannot comply with the request within that time,he shall so inform the individual,and may have an addidonal 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 pri�•ate data concerning himself. To exercise this right,an individual shall norify in wridng the responsible authoriry describing�he nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nocify past recipients of inaccurate or incomplete data, including recipients named by the individual; or(b)notify ihe 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 determination of the responsible au[horiry may be appealed pursuant to the provisions of the administradve 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 pernut or license from the City of Orono or any of its departments may require you to fumish certain private or confidential information. You are notified that: 1, The information you furnish will be used to determine your qualification for the pemut 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 pernut 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. (. Your full name is required to process this application or permit. , � C� � ��, I�� J �� I � � � First Middle � \ Last r � � �>- � � Address � /� �� "T �� ,>'� l! ` � �� / / Ciry State Zip Phone I understand my rig s as stated a ove. Signature