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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 ro supply private or confidential dara concerning himself shall be informed of: (a)the purpose and iatended use of the requesred dara within the collecdng'state agency,political subdivision,or statewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any Imown consequence arising from his supplying or refusing to supply priva[e or confidendal data;and(d)the idenriry of other persons or endaes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesagaave dara, pursuant to section 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav place the nodce reauired under this subdivision in the individual income tax or propertv tax refund instructions inscead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whe[her i[is classified as public, private or confidendal. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown che data wi�hout any charge to him and, if he desires, shall be informed of the content and meaning of that data. Afrer an individual has been shown che private data and informed of its meaning,the data need not be disclosed to him for six monrhs thereafter unless a dispute or acrion pursuan[to this secrion is pending or addidonal data on the individual 6as been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the actual costs of making, certifying, and compiling the copies. The responsible authoriry shall compty 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 request wichin that time,he shall so inform the individual,and may have an addirional 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 private data concerning himself. To exercise this right,an individual shall noafy in wriring the responsible authoriry describing rhe narure of the disagteement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of inaccurate or incomplete data, including 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 the individual's statement of disagreement is included with the disclosed data. The de[ermination of the responsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act reladng 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 pemut 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 detemune 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 [o the extent necessary to process the pemut 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. (. Your fuli name is required to process this applicat'on�or permit. VU �� ' First Middle Last � `�I `7 C �.Y)�I►xrc�� (��i L� Address �,� �" �`�(� � �J�—�� `�.�.�� ;�� N� y - Ciry State Zip Phone I u derstand my ri ts as st ted ab ve. _._._� Signature