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� . - t Sec.13.04 RIGHTS OF SUBJECTS OF D�1TA Subd. 1. Type of data. The rights of individual on whom che data is scored or co be stored shall be as set fonh in this secrion. Subd.'_. Information required to be given individual. An individual asked to supply private or confidenrial data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the coilecting"state agency, polibcal subdivision,or statewide system; (b)whe[her he may refuse or is Iegally required to supply the requested data:(c)any k�own consequence arising from his suppiying or refusing to supply priva[e or confidential data;and(d)rhe iden[ity of other persons or enrities authorized by state or federal law to receive the data. 'Ihis requirement shall not apply when an individual is asked to supply invesrieaave dara,pursuant to secaon 13.82, subdivision�, to a law enforcement o�cer. The commissioner of re��enue mav place the noace reauired under this subdivision in the individual income tax or proDerrv tax refund instructions insread of on chose forms. Subd. 3. Access to data by indi�-idual. Upon reques[to a responsible authoriry,an individual shall be informed whe[her he is the subject of stored data on ind;viduals, and whether i[is classified as public, private or confidenoal. Upon his further request,an individual who is[he subjecc of stored private or public data on individuals shall be shown the data wi�hout any cnarge to him and, if he desires, shall be informed of the content and meaning of[hat data. Afrzr an individual has been shown the private data and informed of its meaning, the data need not be disclosed to hirn for six months thereafter unless a dispute or acrion pursuanc to this secdon is pending or additional data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon requesc by the individual subject of the dara. The responsible au[horiry may require[he requesting person ro pay the actual cosu of making,certifying, and compiling the copies. The responsible au[horiry shall comply immediately, if possible, with any request made pursuant to this subdivision, or wi[hin five days of the date of the request,excluding Saturdays,Sundays and leeal holidays,if immediate compliance is not possible. If he cannot compiy with the request within tha[time,he shall so infor*n the individual,and may have an addiaonal five days within which to comply with the request,exc!uding 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 conceming himself. To exercise this right,an individual shall noafy in wricing che responsible authority describing�he nacure of the disagreement. The responsible authoriry shalt wi[hin 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of inaccurate or incomplece data, inciuding recipients named by [he individual; or(b)notify the individual that he believes�he data to be correc[. Data in dispute shall be disclosed only if the individual's statemenc of disagreement is included with the disclosed data. The de[ermination of the responsible authority may be appealed pursuant to the provisions of the administrarive procedure act relaang 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 that your reauest for a permit or license from the City of Orono or any of its departments may require you to furnish certain private or contidential information. You are notified that: 1. The information you furnish will be used to determine your qualification for the pernut 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 permit or license. 4. If your requested permit or license requires Council action to approve, some information may become public. 5. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. (. Your fuil name is required to process this application or pemut. /7 -, � '-- ,� �, .• -- i � � � �� r"�!\. f � � �� ,�' vfiddl Last First ! � � ,�. ��y��F\ �,�c�t�: r�,�`Z � `'�� , J� A re�s , �� .-�. -- r /`� -- � ��`�� - � �'/ / r��_ —_-_' City State Zip Phone I under and my ri�hts as stated above. � � . / �_- �� - '�,5n�ture ��