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. � . Sec.13.Q4 RIGFiTS OF SUBJECTS OF DATA ' Sutd. 1. Type o[data. The righcs of individual on whom�he dara is scored or co be stor•d shall be as sec forch in this secaon. Subd.2. IatormaCoa required to be given indiridual. An individuaI uked w supply privare or coafideadal data concerning himsetf shaIl be informed oE: (a)the purpose and imm�ded use of the rzquesud dara wichia the eollecdng 2tate ageaty,golidcai subdivision,or sca�wide rysc:m; (b)whet;er he tr3y r.:vs�oi u,legalIy requir.d co supply the rquesud dat+:(cj any 3�own coasequ:nce arisiag fram his supplying or tefusing to suppiy privace or con�ider.cal data;and(d)the ideedry of acherpersoas or enodes au�oriz:d by sc�ce ar fed�ral law eo receive t�e da�. This r.quireme�;:�_'; noc apply when an ir.dividual is uked to supply invesdgadve dan,pursuanc ro secdoa 13.82,subdivision S,co a!aw enfaccement ofncer. � 'i�e eenm�ssioner of revenua mav olace.the naace r_auird under this subdivision in the individual income e►x or oroaem taz refund inscrucdons insuzd of on chose forms. Subd.3. Access to data by individual. Upon requesc ta a cesponsible auchoriry,an iadividual shall be infocmed whecher he is che subjecc af stor:d dan on individuals,and whecher it is cfassiFed as public,private or canF.dendal. Upaa his furcher rcquesc,an individual who is che subje:c of scored priva:e or public dam on individuals shall be shown�he daa wichout any chacge ro him and;i['he desiru,shall be infocmed of the eoatenc ar.d m:aning of that data. After an individual has been showa the privare daa and informed o(ies meaaing,che data ae:d noc be disclosed oo him for siz monchs�hereafu�unless a d'upuce or acaon pursuanc to chis secaon is pending or addidoaal dan on thc individual has been eolle:�d or creamd. The respaasibie auchoriry shall pcovide eopies of che priva4 oc publie daca upon tequest by che iadividual subject of che daca. 'Ihe responsible auchoriry may requir_ �he requesdng person ro pay the accual coses oi making,eerrifying,ar.d compiling the copies. 'Ihe responsible auihoriry shaIl eomply immediacaly,if possible,wi�h aay requesc made pur5uanc to chis subdivision,or wi�hin five days of the da�e of�he requesc,exctuding Sacurdays,Sundays and legal holidays,if imcnedia�e compliaace is not possible. If he eanaoc eomply with the requesc wichin�hac ame,he shall so inform che individuat,and may have an addidooal fiv:days within which to compty wich the request,ezcluding Sacurdays, Sandays and legal holidays. . . I • , I Subd.4. Procedure when data is not accurate or eomplete. An iedividaal may conc:st the accurncy or eomple�eness of pubiic orprivate i dara conceming himself. To execcise this right,an individuai shaIl aodfy in wridng che responsble au�horiry describing the nature of the disagreemenc. 'Ihe responsible authoriry shall wichin 30 days eicher: (a)correc�che data faund to be inaccurate or incomptete and aaemp�to nadfy pasc recipien�s of � inaccu�ate or incamplece data,induding recipiencc named by the individual;or(b)aoaEy the individual thac he believes[he da�a to be cocrecc Dat� i in dispa�e shall be disclosed onIy if the individual's sta[entnt of disagrcem:nt u includtd wich the disclosed data. The determinadon of the responsibta au�horiry may be appealed pursuant to the provisions of the adminisaarive procedure act reladng to contesmd cases. - DATA PRIVACY ADYISORY � In accordance wich M.S. 13.04,Subd.2, "Ri�hcs of subjecu of data", we would like to inform you that your request for a permit or license from the City of Orono or any of its departments may require you to furnish certai.n private or confidential information. You aze notified that: 1. The information you furnish will be used to determine your qualification for the permit orlicense 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 wich other local, stace or federal a�encies to the ettent necessary to process , the permit or licease. 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 (ava.ilabie upon request) to review private data on yourself. 6. Your full name is required to process this applica�ioa or perm.i[. L=v/�� ' ;%�ll./`^�ri��i"�� Firsc �tiddle I.ast � Address Ciry Sate Zip Ptiaae I understand,ai��;hts zs stated above. � ----��" "� � - . Sigtuture