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. � Sec.13.04 R/GHTS OFSUBJECTS OFDATA ` Subdivisron/. Type oJdata. The rights of indivrdua!on tivhom the data is stored or to be stored shall be as set fortn cr this section. Subd.2. Injormation required to be given individuaL An rndrvidua!asked to supp[y prrvate or confidentra!data cer._;.-ning himself shall be informed of.' (a)the purpose and intended use of the reguested data wrthin the co!lecting state agency,politica!subdrvrscr.or statetivide system;(bJ whether he may refuse or rs legally required to supply!he requested data;(c)any knotivn consequence arising from r�s:�pplying or refusing to supplyprivate or confrdentra!data;and(d)the idenliry oJother persons or entrties authorired by state orfedera!!mv to r::zn�e the data. This requrrement shal!not apply tivhen an indrvidual!s asked to supply investigative data,pursuant to section 13.82, subdii�:�n�, to a!mv enjorcement offrcer. The commissioner ofrevemee may place the notice required under lhis subdivisron in the indivrdual rncome tax or pr�---n tax ref:�nd instructions instead of on those/orms. Subd.3. Access to data by individual. Upon request to a responsible aulhority,an individual shal!be injormed ivhethzr��s the subject oJstored data on indrviduals, and whether it is dassifred as public,priva�e or confrdentiaf. Upon his further request, an indn-,:1s!ivho rs rhe subject ojstored private or public data on rndividuals shall be shoivn the data ivithout any charge to him and, rf he desrres,shc::=�informed oJ the content and meaning of that data. Ajter an indivrdual has been shotvn the private data and informed of its meaning, the c:::.:need not be disclosed to him for six months thereafter unless a dispute or action pursuan!to lhis section is pendmg or addrtiona!data on d:�:r.,�ividual has been collected or created. The responsible authoriry shal!provide copies ojthe private or public data upon request by the rndn:�::al subject oj the data. The responsible authorrty may require 1he requesting person to pay the actua!costs of making, certifyrng,and compi::r:the copies. The responsrble authority shal/comply immedialely,if possible,with any req:�es�made pursuant to this subdivision,or �::;irn five dm s ojthe date ojthe request,excluding Salurdays,Sundays and lega!holydays,ijimmediate complrance is no!possrble. If he canncr_:mply tit�rth the request tivithin that time,he shal!so inform the rndividual,and may have an additional frve days ivithin�vhich to comp/y tivith the rz:>>st.excluding Saturdays,Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest!he accuracy or completeness oi::.�:rc or prii�ate data concernrng himself. To exercise this right, an individual shal!no�ify in writing the responsible authority describrng v-: �ature of the disagreement. The responsible authority shal!ivrthin 30 days erther: (a)correct the damfound to be inaccurate or incomplete anc:-.mpt ro notrfy post reciprents ojinaccurate or incomplete datq includingrecipients named by the indivrduo(;or(bJ no1�the individua!that hz�_::ati•es Ihe data to be correct. Data in dispule sha![be disclosed only if the individua!'s stalement of disagreemenl is inc[uded with the disclose:i.:;::a. The determrnatron ojthe responsible authority may be appealed pursuant to the provisrons of the admrnistrative proce.::.��act relating to contested cases. DATA PR/VACYADvlSORY In accordance with MS. 13.04,Subd.2, "Righ[s ojsubjects ojdata",ive ivould like!o rnform you that your reqi�estjor c-_-^�it or lrcense from the City ojOrono or any of its departments may require you to furnish certain private or confrdentra!rnjormation. You are notijied that: I. The information you furnish ivr!!be used to determrne your qualrfrcahon jor the penni!or lrcense requesrr: 2. Yot�may refuse lo supply data, bu!refusal may require Ihat!he Crty deny the permit or license. 3. The rnformatron may be shared with other local,state or jederal agencies to the extent necessory to proca:_:ne pennit or license. d. Ifyour requested permit or lrcense requires Counerl action to approve,some rnformation may become pu�.:_ 5. You have certain rights under M.S. 13.0�1(see jolloiving page)[o revieiv private data on yourself. 6. Your full name is required to process this application or permit. PLEA PRINT n C�f�' ' - �� t'l,� t.¢z�-. First h�liddle Last Address City Slate Zip Phone 1 un ry rights as stated above. Signat e !0