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. , Sec.13.04 RIGHT'S OF SLIBJECTS OF DATA Subd. 1. Type of data. 'I�e rights of individual on whom[he data is scored or to be stored shall be as set forth in this secdon. Subd.2. Information required to be given indiridual. An individual asked to supply private or co�dendal data concerning himself shall be informed of: (a)the purpose and intended use of the requested data wi�hin the collecting'state agency, political subdivision,or stacewide system; (b)whether he may refuse or is legally required to supply the requested data;(c)any imown consequence arising from his supplying or refusing to supply private or confidendal data:and(d)the identiry of other persons or enaries authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesogadve data, pursuant to secrion 13.82, subdivision 5, [o a law enforcement officer. The commissioner of revenue mav place the noace required under this subdivision in the individual income tax or propertv tax refund instructions instead of on those forms. Subd. 3. Access to data by individuai. Upon requesc to a responsibte authority,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�denual. Upon his further request, an individual who is the subject of srored private or public data on individuals shall be shown the data without any charge to him and, if he desires, shal]be informed of the content and meaning of that data. After an individual has been shown the private data and informed of irs meaning,the data need no[be disclosed to him for six months thereafter unless a dispute or action pursuant to this secaon is pending or addidonal data on[he individual has been collected or created. The responsible authority shall provide copies of the private or pubtic dara upon request by the individual subject of the data. The responsible auchoriry may require the requesting person to pay the actual coscs 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. If he cannot comply with the requesc within that time,he shall so infornt 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 contesc the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shall notify in writing the responsible au[horiry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt ro nodfy past recipients of inaccurate or incomplete data, i�cluding recipients named by the individual; or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disciosed only if the individual's statemen[of disagreement is included with the disc(osed data. T'ne determination of the responsible authoriry may be appealed pursuant to the provisions of the administncive 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 reques[ for a pernut 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. 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 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. ��i cJl S �7�t��S c�/ First / Vliddle Last Zr�U/ ��s�v ��• �c% Address (��i �Z S�y C/!!/.�✓ C�n, State Zip Phone I under d my rights as stated above. 1 " �'" � Signa re