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Sec.13.04 RIGHTS OF SUBJECTS OF DaT� Subd. 1. Tvpe of data. The righ[s of individual on whom[he data is scored or co be stored shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. Act individual asked to supply private or co�dentiai data conceming himself shall be infoaned of: (a) the purpose and intended use of the requested data within the collecting"stace ageocy,polidcal subdivision,or sratewide system; (b)whether he may refuse or is legally required to supply the reques[ed data;(c)any Imown consequence arising from his supplying or refusing to supply priva�e or conr�dential data;and(d)rhe idenciry of ocher penons or enddes au[horized by sta[e or federal law to receive the data. This requiremeot shall not apply when an individual is asked to supply invesrigadve dara, pursuan[to secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of re��enue mav place the noace reouired under this subdivision in the individual income tax or propertv tax refund instructions insread of on chose forms. Subd. 3. �ccess to data by indi��dual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subjecc of stored data on individuals, and wherher it is ctassified as public, private or confidendal. Upon his further request, an individual who is[he subject of stored private or public data on individuals shall be shown rhe data wirhou[any charge to him and, if he desires, shall be informed of the content and meaning of[hat data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed[o him for six months thereafter unless a dispute or acaon pursuant to this section is oending or addidonal data on[he individual has been collected or created. The responsible authoriry shall provide copies of the privace or public data upon request by the individual subject of the data. The responsible authority may require che requesting person to pay the acrual cos�s of making, cercifying, and compiling the copies. The responsible au[horiry shall comply immediately, if possible, with any request made pursuant to this subdivision, or within five days of the date of[he request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply wi[h the request within that time,he shall so inform the individual,and may have an additional five days within which[o comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure wheo data is not accurate or complete. An individual may contest the accuracy or completeness of public or pri��ate data conceming himself. To exercise this ri¢ht,an individual shall notify in wridng the responsible authoriry describing[he nature of the disagreement. The responsible authoriry shall within 30 days either. (a)correct the data found ro be inaccurate or incomplere and attempt to nodfy past recipients of inaccurate or incomplete data, inciuding recipients named by the individual; or(b)notify the individual that he believes the data to be correcc. Data in dispute shall be disclosed only if[he individual's statement of disagreemen[is included with the disclosed data. The determina[ion of�he responsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act relacing to contested 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 reauest 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 pemut 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. j. 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. w ��-�1`� � �r , �--�`� Firs[ Vliddle Last � �1 �"1 S L �'h,' w� � � L�Ir� Address ' 3 C �,� � -� � �rr.� ss � i��`- ,�i �� - c 5 1 Cih, State Zip Phone I understand my ri�hts as stat d a ve. , Signacure '