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�. . , Sec.13.04 RIGHTS OF SUB.TECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to suppiy private or confidenrial dara concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting'state agency,polidcal subdivisio�,or sratewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any lrnown consequence arising from his supplying or refusing to supply private or confidenrial data;and(d)the identiry of other persons or endaes authorized by state or federal law to receive the data. This requiremenc shall not apply when an individual is asked to supply investieadve dara, pursuant to secaon 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of revenue mav place the notice reauired under this subdivision in the individual income tax or propertY tax refund instructions inscead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whecher it is classified as public, private or confidenrial. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data wi[hout any charge to hun and, if he desires, shall be informed of the content and meaning of[hat data. Afrer an individual has been shown[he private data and informed of ics meaning,che data need not be disclosed to hun for six months thereafter unless a dispute or acrion pursuan[to this secdon is pending or addidonal data on the individual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by the individuai subject of the data. The responsible authority may require the requesting person to pay the actual coscs of making, certifying,and compiling the copies. The responsible authority shall comply immediately,if possible, with any request made pursuant to this subdivision,or within five days of the date of the request,exciuding Saturdays,Sundays and legal holidays,if immediate compiiance is not possible. If he cannot comply with the request within that time,he shall so inforcn che 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 conceming himself. To exercise this right,an individual shall norify in writing the responsible authoriry 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 to norify past recipienu of inaccunte or incomplete data, including recipients named by the individual; or(b)noafy ihe individual that 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. The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act relaring 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 request for a pernut or license from the City of Orono or any of its departments may require you to fumish 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 pernut or license. 4. If your requested permit or license requires Council action to approve, some information may become public. g, 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. �� -�-��,� �_ �� 1�-� i�� l'� First Middle Last �� 7 S L �'C��,'�.' �-:� �� l.�lr'1.� �V r`Yl �. r`-�6� 1��;,�,�� ` : � � � c �-1 ��- � � �� Ciry State Zip Phone I understand myr�rig s as stated above. I , , ; .; �'�`' Signature J