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� Sec.13.04 RIGHTS OF SUBJECTS OF DAT?, Subd. 1. Type of data. The righ�s of individual on whom the data is s[ored or to be stored shall be as set focth in this secrion. Subd.2. Information reqtrired to be givea individual. An individual asked to supply private or confidenrial data conceming himself shall be informed of: (a) the purpose and inttnded use of the requested dara within the collecdng"state agency,political subdivision,or statewide system; (b)whecher he may refuse or is legally required to supply the requested data;(c)any 1�own coasequence arising fmm lus supplying or refusing[o supply • priva[e or confidendal dan;and(d)the idendry of other pzrsoas or enaaes authorized by state or federal law to receive the data. This requiremeat shall noc apply when an individual is asked to suppty invesdeadve dam, punuant ro secdon 13.82, subdivision 5, to a law enforcement o�cer. - The commissioner of revenue mav place the noace reauired under this subdivision in the individual income tax or propem tax refund instrucrions inscead of on those forms. Subd. 3. Access to data by indiridual. Upon requesc to a responsible au[horiry,an individual shall be informed whe[her he is the subject of scored data on individuals,and whe�her it is classified as public, private or confidenrial. Upon his funher request, an individual who is the subjecc of stored private or public data on individuals shall bz stiown che data wichout any charge to him and, if he desires, shall be informed of the conten[ and meaning of chat data. Afrer an individuai has been shown che private data and informed of its meaning, the data need not be disclosed to him for six monchs chereafter unless a dispute or acrion pursuant to ehis secdon is pending or addidonal data on the individual has been collected or created. The responsible authoriry shall provide copies of the privace or public data upon requesc by che individual subject of the data. The responsible authoriry may require the requesdng person to pay the accual costs of makine, certifying, and compiling the copies. The responsible authoriry shall comply immediately, if possible, with any requesc made pursuan[to this subdivision,or within five days of the date of the requese,excluding Saturdays,Sundays and legal holidays,if immediace compliance is noc possible. If he cannoc compty with the request within chac time,he shall so inform the individual,and may have an addiaonal five days wi[hin which to comply wi[h the request,excluding Saturdays, Sundays and legai holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of pubiic or private data concerning himself. To exercise this rieht,an individual shall noafy in wridng the responsible authori[y describing the nature of the disagreement. The responsible auchoriry shall within 30 days either: (a)correct the data found ro be inaccurate or incomplete and attempt[o nodfy past recipients of inaccunte or incomplete data, including recipien¢named by the individual; oc(b)nocify the individual that he believes rhe 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 determinarion of the respo�sible au�horiry may be appealed pursuanc to the provisions of the administradve procedure act relating to contesced 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 Ciry 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 wiit 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 perm.it 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 righ[s 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. Se� � �� 6�,-�-�--r Firsc Middle Lasc �S`f r� �- Address � ��a. Z, � �-� �� x�� Ciry State Zip Phone I understand '�hts as stated ab n � L� 5ignature �