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� t Sec.13.04 RIGHTS OF SLlB.TECTS OF DAT,� Subd. 1. Type of data. 'Ihe rights of individual on whom the data is stored or to be stored shall be as set forth in[his secdon. Subd.2. Information reqtrired to be�ven individual. hn individual asked to supply priva�e or confidenaal data concerning himseif shall be informed of: (a) the purpose and incended use of the requesrEd dara wi�hin the coliecang'state ageocy, poliacal subdivision, or sracewide system; (b)whether he may refuse or is legally required to supply[he requested dara;(c)any Imown consequence arising from his supplying or refusing to supply privace or confidenoal da�a;and(d)the idenary of other persons or enooes authorized by stace or federal law to receive che dara. This requirement shall noc apply when an individual is asked co supply invesdgaave data, pursuan�to secaon 13.82, subdivision 5, to a law enforcemeac o�cer. The commissioner of revenue mav place the noace required under this subdivision in [he individual income tax or orooem taz refund insrrucrions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible auchoriry,an individual shall be informed whecher he is the subject of stored data on individuals,and whecher it is ciassified as public, privace or confidenaal. Upon his furcher request, an individual who is the subject of stored private or public data on individuals shall be shown che data without 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�he private dara and informed of iu meaning, [he data need noc be disclosed to him for six mon�hs thereafter unless a dispuce or acrion punuanc to chis section is pending or addidonal data on che individual has been collecced or created. The responsible authoriry sha11 provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesring penon to pay the accual costs of making, cerrifying, and compiling the copies. The responsible authoriry shall comply immedia[ely, if possible, wi[h any request made pursuant to this subdivision, or within five days of the dace of the requese,excluding Satuidays,Sundays and legal hofidays,if immedia�e compliance is noc possible. If he cannot comply with the requesc wichin thac tune,he shall so inform tbe individual,and may have an addinona!five days wichin which to comply with the request,excluding Sacurdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of pubiic or private data concerning himself. To exercise rhis right,an individual shali norify in wriang the responsible au[horiry describing the nature of[he disagreemeat. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurace or incomplete and attempt to norify past recipients of inaccunte or incomplete data, including recipienes named by che individual; or(b) nodfy the individual thac he believes the data to be correct. Data ' in dispute shali be disclosed only if[he individual's stacement of disagreement is inc(uded with the disclosed data. The determination of ehe responsible au[horiry may be appealed pursuant to the provisions of the adrtunis�aave procedure act relaang to contested casas. 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 che City of Orono or any of its departments may require you to furnish cenain 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 agencies to[he extent necessary to process the pemut or license. 4. If your requested permit or license requires Council action to approve, some information may become public. 5. You have certai.n rights under M.S. 13.04 (available upon request) to review private data on yourself. 6. Your full name is required to process this appiication or permit. �'�-�-��1. �/L ��%�'�%,�j�'�.� First �tiddle Last �� , � � �i � . , �� .�„� ,� Addross � �c"`l k�to�%� >>/-�� >�.�/ i�� C��y State Zip Phone I understand my righu as stated above. _.--, �� ( � . ` _'G ti!'✓ ' :.-Z-��L� ��-i� Signature