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Sec.13.04 RIGHTS OF SUBJECTS 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. Informatioo reqirired to be given individual. �t individual asked to supply private or confidenual data conceming himself shall be informed of: (a)the purpose and intended use of the requested data wi[hin the collecting'state agency,polidcal subdivision,or sratewide system; (b)whether he may refuse oY is legally required to suppty the requested data;(c)any lmown consequence arising from his supplying or refusing to supply privace or conridendal data;and(d)the identity of o[her persons or endaes au[horized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesrigadve dara, pursuant to secdon 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 instead of on those forms. Subd. 3. Access to data b�individual. Upon request to a responsible au[hority,an individual shall be informed whether he is the subject " of stored data on individuals, and whe[her it is classified as public, privace or confidenaal. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data wichout any charge to him and, if he desires, shall be informed of the con[ent and meaning of that data. Afrer an individual has been shown the private data and informed of ics meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acrion pursuant to this secaon is nending or addiaonal data on the individual 6as been coilected or created. The responsible authority 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 makine, certifying,and compiling the copies. The responsible auchoriry sha11 comply immedia�ely, if possible, wi[h any request made pursuant to this subdivision,or within five days of the date of the requesc,excluding Saturdays,Sundays and legal holidays, if immedia[e compliance is not possible. 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,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may conrest the accuracy or completeness of pubiic or priva[e data concerning himself. To exercise[his right,an individual shall notify in writing the responsible authoriry dzscribing[he nature of the disagreement. The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past reci�iients of inaccurate 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. Tlte derermination of the responsible authoriry may be appealed pursuant to the provisions of the administrative 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 permit 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 a?encies 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. 6, Your full name is required to process this application or permit. � /-��-G�� S c. rtr�,o�r First Middie Last Address City State Zip Phone I understand my rights as stated above. < �i'._ Z�xxR--- � Signature