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� � Sec.13.04 RIGHTS OF S[1BJECTS OF DAT�1 Subd. l. Type of data. The righ[s of individual on whom che data is stored or co be stored shall be as se[forrh in this secrion. Subd.2. Information required to be given individual. An individual asked to supply private or confidendal data conceming hitnself shall be informed of: (a)the purpose and intended use of the requested data within the collecting'state agency, politicai subdivision,or sratewide system; (b)whether he may refuse oY is legally required to supply the requested data:(c)any}�own consequence arising from his supplying or refusing to suppty private or co�dendal data;and(d)the iden[iry of other persons or enrides authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to suppty invesdeadve data, pursuant 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 indi��dual. Upon request to a responsible authoriry,an individual shali be informed whether he is the subject of stored data on individuals, and whether it is classified as public, private or confidenaal. Upon his further request,an individual who is the subjec[ of s�ored private or public data on individuals shall be shown the data wichout any charge to him and, if he desires, shall be informed of the content and meaning of that data. After an individual has been shown the private data and informed of ics meaning,the data need not be disclosed[o him for six months thereafter unless a dispute or acrion pursuant to [his secrion is pending or addidonal data on the individual has been collected or created. The responsible authoriry shail provide copies of[he privace or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the ac�ual cosu of makin¢, certifying; and compiling the copies. The responsible authoriry shall comply immediately, if possibte, with any request made pursuant to this subdivision, or wi[hin 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 request within that time,he shall so inform the individual,and may have an additional 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 rieht,an individual shall norify in wri[ing the responsible authority 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 nodfy past recipients of inaccurate or incompiete data, including recipients named by the individual; or(b)notify the individual tha[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. T}ie determinaaon of the rzsponsible authoriry may be appealed pursuant to the provisions of the adminis[rarive procedure act relaring to con[ested 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 thar. 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 tha[ the City deny the pemut or license. 3, The information may be shared wich other local, state or federal agencies to the extent necessary to process the pernut or license. 4. If your requested pemut or license requires Council action to approve, some information may become public. j. 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. _ � �-- �'�/ L �i_��. i �� First Middle Last �� .� �l��'/��f/P/(/ � ��`�. �/ Address � �� "1 G r 1 S � ,� / ��?� �� �T State Zip Phone City I understand my rights as stat �bove. � �/��/' � ' namre � r / ��;