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` �. . se�.i3.oa Fucx�rs oF su�.rEcrs oF naTa Subd. 1. Type of data. 'Ihe rights of individual on whom ehe dara is stored or to be stDrrd shall be as set forth in this secaon. Subd.2. Informatioa reqirired to be given individual. An individual asYed to suppfy private or confidendal data concerning hi�self shall be informed of: (a)the purpose and inteaded use of the requested dara within the collecang�tate agency,policical subdivision,or smtewide rystem; (b)whether he may refuse oY is legally required to supply the cequested data;(c)any lmown coasequence arising from his supplying or refusiag to supply private or confidendal dara;and(d)the idendry of other penoas or enriries authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invadgaave data, pursuant to secdon 13.82,subdivision 5, to a law enforcemen[ofFicer. 'Ihe commissioner of revenue mav olace the nodre reouired under chis subdivision in the individual income tax or orooem raz refund instrucdons inscead 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 tfie subject ' of scored data on individuals,and whe[her i[is classified as public, private or confidendal. Upon his funher request,an individual who is the subjecc of stored private or public data on individuals shall be shown ehe data wichout any charge to him and,'if he dasires,shall be informed of the content and meaning of that data. Afrer an individual has been shown the privace data and informed of irs meaning,the data need not be disclosed to him for six monrhs thereaher uniess a dispuce or acdon pursuant to chis secdon is pendiag or addidooal data on the individual has beea collected or creared. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the dara. The respoasible authoriry may require the requesting person to pay the actual coses of making, cerafying,and compiling the copies. The responsibte 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 aad legal holidays,if immediate compliance is not possibie. If he caanot comply with the request within that ame,he shall so inform the individual,and may have an addirioaal five days within which to comply wich the request,excluding Sacurdays, Sundays and legal holidays.. Subd.4. Procedure when data is not accurate or complete. An individual may concest the accu�acy or completeness oE public or private data concerning himself. To exer�ise this right,an individuai shall noafy in wridng the responsible auchoriry describing the nacure of[he disagreemen� The responsible authoriry shall within 30 days either: (a)correct the data found[o be inaccucate or incomplece and attempt to nodfy past recipienu of inaccurate or incomplece data, including recipients named by the individual; or(b)noafy the individual[hat he believes the dara to be correct Data in dispuce shall be disclosed only if the individual's statement of disagreement is included wi[h the disclosed dara. The determinadon of the responsible authority may be appealed pursuant to the provisions of the adaunistradve procedure act reladag to contesced cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Ri;hts 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 ue 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 exten[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 ri�hts 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. �.��; s �ol�„� lto/�,�s�t �r — gin� Middle I.ast 3�2 5 S�a�,� s f�1 uc� Address �Y�Nz r� 7`,q i'y!<�, �S3�( �Y73 - �7`/ S �7 � Ciry State Zip Phone I understan my rights as sta[ed above. Signacure