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� . � Sec.13.04 RIGEiTS OF SUBJECTS OF DaTA Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be storcd shall be as set forth in this secrion. Subd.2. Information reqirired to be givea individual. An individual asked to supply privace or confidendal data concerning himse(f sfiail be informed of: (a)the purpose and inceoded use of the requested dara wi[hin the collecdng�tate agency,polidcal subdivision,or sracewide rysum; (b)whecher he may refuse or is legally required to suppiy the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidenaal data;and(d)the idendry of other pecsoas or enrides authorized by stace or fede�al law to receive the data. T'his requirement shall not apply when an individual is asked to supply invesdgadve dam, pursuant to secdon 13.82,subdivision 5, to a law enforcement officer. The commissioner of revenue mav place the nodce reouired undcr this subdivision in the individual income tax or prooem taz refund instrucdons instead of on chose forms. Subd. 3. Access to data by individual. Upon request to a responsible auchoriry,an individual shall be informed whether he is the subject � of scored data on individuals,and whe[her it is classified as public,privace or confidenual. Upon his further request, an individual who is the subject of stored private or public data on individuals shall be shown the dara wichouc any charge to him and.'if he desires, shall be informed of the content and meazung of[hat data. Afrer an individual has been shown the private data and informed of its meaning,the dara need not be disclosed to him for six mon[hs thereafter unless a dispuce or acaon pursuanc to chis secdon is pending or addidonal dara on the individual has been collected or creared. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the dara. The responsible authoriry may tequire the requesdng person to pay the accual cosu of making,certifying,and compiling the copies. The responsibfe authoriry shall comply immediately,if possible,with any request made pursuanc to this subdivision,or wi�hin five days of the date of the request,ezcluding Sacurdays,Sundays aad legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that cime,he shall so inform the individual,and may have an addiaonal five days within which to comply wirh 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 chis right,an individual shall nodfy in wriang che responsible aurhoriry describing the naarre of the disagreemenc The responsible authoriry shall within 30 days either: (a)correct the data found w be inaccurate or incomplece and attempt to nodfy past recipients of inaccurate or incomplete data, including recipientt named by[he individual; or(b)nodfy the individual[hat he believes the data to be cocrect Data in dispute shall be disclosed only if[he individual's statemenc of disagreemenc is included with the disclosed data. The decerrtunadon of the responsible authoriry may be appealed pursuanc to the provisions of the administradve procedure act relating 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 tha[your request for a permit or license from the City of Orono or any of its departments may require you to furnish certain priva[e or confidential informa[ion. You are notified that: 1. The information you furnish will be used to determine your qualification for the perm.it 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 ocher 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 informa[ion may become public. 5. 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 applicatio❑ or permit. `��' � � ��C� l� � � ,�, � p�� id Last `/C1�L� l.,C��J';� l� �.)�r. Address '` , �,�U� �. ��`� 1 �� ;,�� Ciry State Zip Phone I understand my riQhts' stated above. � . C � Signature