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. , Sec.13.04 RIGHTS OF SUBJECTS OF D�TA Subd. 1. Type of data. The righ[s of individual on whom che data is s[ored or to be stored shall be as set forth in this secrion. Subd. �. Information reqirired to be given individual. An individual asked to supply private or confidential data concerning himself shall be informed of: (a)the purpose and intended use of the requesrPd data within the collecring'stare agency, political subdivision,or statewide system; (b)whether he may refuse oY is legally required to supply[he reques[ed data;(c)any known consequence arising from his supplying or refusing ro suppty private or confidendal data;and(d)the identicy of o[her persons or enddes authorized by state or federal law to receive the data. This requirement shall noc apply when an individual is asked to supply invesrigaave data, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav place the noace reauired under this subdivision in the individual income tax or propem tax refund instructions instead of on those forms. Subd. 3. Access to data bv individual. Upon request to a responsible authority,an individual shall be informed whecher he is the subject of scored data on individuals, and whecher it is classiFied as public, private or confidenaal. Upon his further requesc, an individual who is the subjecc of stored private or public dan on individuals shall be shown che data wichout any charge to him and, if he desires, shall be informed of the content and meaning of that data. After an individual has been shown the private data and informed of iu meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acrion pursuant to [his secrion is pending or addidonal data on the individual has been collected or created. The responsible authority shail provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesring person to pay the acmal costs of making, certifying, and compiling the copies. The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision, or within five days of the date of the request,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possib[e. If he cannot comply with the request within that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,exciuding Sarurdays, Sundays and legal holidays. Subd.4. Pi'ocedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or pri��are data conceming himself. To execcise this right,an individuai shall nodfy in writing the responsible authoriry describing the natttre of the disagreement. The responsible authoriry shall within 30 days ei[her: (a)correct the data found to be inaccurate or incomplete and attempt to noafy past recipienu of inaccutate or incomplete data, including recipients named by the individual; or(b)notify the individual that he believes the 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 determinaaon of the responsible authority may be appealed pursuant to the provisions of the administrarive procedure act relating 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 permit 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 determine 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 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 ri�hts under M.S. 13.04 (available upon request) to review private data on yourself. 6. Your.fuli name is required to process this application or permit. �-- � /`, n��'��'� �� T� 1 � First , M}c�d1e� Last l� S� , � L' ' Addre / � -� 2-� , �3 �" j ��! �^� ��1 S � � � � - State Zip Phone City I understand my ri�hts as sta�d above. C Z' � LL '�`"�-_-__� Signature