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. _ . , � . Szc.13.04 RIGHTS OF SLIBJECTS OF D,�T�. Subd. 1. Type of data. The righ[s of individual on whom[he data is stored or to be scored shall be as sec forth in chis secaon. Subd.Z. Information reqirired to be given individual. ?.n individual asked to supply private or confidential data concerning himself chall be informed of: (a)the purpose and incended use of che requesced dara within the collecring'state agency, political subdivision,or sra[ewide rysaem; (b)whether he may refuse or is legally required to supply che requested data;(c)any imown coasequence arising from his supplying or refusing to supply pnvace or confidenna!data;and(d)the identiry of o[her persons or enddes auchorized by state or federal law to receive the data. "Ihis requirement shall noc appty when an [ndividual is asked to supp�y invesrigadve dara, pursuant ro secnon 13.82, subdivision�, ro a law enforcement officer. The commissioner of revenue mav vlace che norice required under this subdivision in the individual income tax or prooem rax refund insrrucrions instead ot on those forms. Subd. 3. ,�.ccess to data by indiridual. Upon request to a responsible au[horiry,an individual shall be informed whe�her he is the subject of s[ored data on individuals, and whecher it is ciassified as public, private or contidenrial. Upon his further request,an individual who is the subjecc oi stored private or public data on individuals shall be shown the data without any charge to hun and, if he desires, shall be informed of the co�ten� and meaning of tha[data. Afrer an individual has been shown the private data and informed of ics meaning, [he data need no[bz disctosed to him[or six months [hereatter unless a dispute or action pursuan[to [his secdon is pending or additional data on the individual has been collected or crea[ed. The responsible au[hority shall provide copies of[he private or public data upon request by the individual subjecc of[he data. The responsible auchoriry may require the requesting person ro pay the actual costs of making, cerrifying, and compiling the copies. The responsible auchori[y shail compty immediatety, if possible, with any request made pursuant ro this subdivision, or within five days of the date of the reques[,ezc(uding Saturdays,Sundays and legal holidays,if immediate compliance is no�possible. If he cannot comply wi�h the request wi[hin tha[time, he shall so inform[he individual,and may have an addiuo�al five days wirhin which to comp(y with the reques[,excluding Saturdavs, Sundays and legal holidays. Subd.4. Procedure when da[a is not accurate or complete. An individual may contesc the accuracy or comoleteness of public or privace data concerning himself. To exercise chis nght,an individual shall nodfy in wridng the responsible authoriry describing che nature of the disagreemea[. The responsible authority shall wi[hin 30 days eicher: (a)correcc[he data found ro be inaccurate or incomplete and attempc to nodfy past recipienrs of inaccurate or incomplete data, including recipients named by �he individual; or(b)noufy the individual thac he believes che data to be correct. Dara in dispute shall be disclosed only if the individual's sta[ement of disagreement is included wi[h the disctosed data. The determination of the responsible au[honty may be aopealed pursuan[to the pro�isions of the administrative procedure act refating to concested 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 pemut or license requested. ?. You may refuse to supply data, but refusal may require that the City deny the pernut or license. 3. The information may be shared with o[her local, state or federal agencies to the e�tent necessary to process the permit or license. 4. If your requested permit or license requires Council action to approve, some information may become public. �. You have certain rights under M.S. 13.04 (available upon request) to review private da[a on yourself. 6. Your full name is required to process this applica[ion or permit. , �� �� . -��r��r� `4idd�j. � Las[ F,��( � �� Addre�sA l f , � � �� I �-? ( —�� VV�v � � Ciry Sta[e Zip Phone I understan m rights as stated above. Signacure