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. ^ Sec.13.04 RIGFITS OF SIJB.TECTS OF DATA Subd. 1. Type of data. The rights of individual ou whom the dact is stored or to be stored shall be as set forth in this secrion. Subd.2. Information required to be given individual. An individual asked co supply private or confidenual dara conceming himself shall be informed of: (a)the purpose and intended use of Ihe requestecl data within the collecring'state agency, polidcal subdivision,or statewide system; (b)whether he may refuse or is legally required to supply the requested dara;(c)any lrnown consequence arising from his supplying or refusing to supply private or confidendal data;and(d)rhe idenaty of other persons or enaaes auchorized by sta[e or fedecal law to receive the data. This requirement shall not app{y when an individual is asked to supply invesdgadve data,pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav piace the nocice required under chis subdivision in the individual income tax or pro�ertv tax refund inscrucaons instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of s[ored data on individuals, and whether it is classified as public, priva[e or confidential. Upon his further request, an individual who is ihe subject of stored private or public data on individuats shall be shown the 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 its meaning, che data need not be disclosed ro hun for six mon[hs thereaiter unless a dispute or action pursuaat to this secrion is pending or addiaonal data on[he individual has been collected or created. The responsible authority shall provide copies o[the private or public data upon request by che individual subject of the data. The responsible authoriry may require the requesting person to pay the actual cosu of making, cerdfying, and compiling the copies. The responsible authonry shall comply immediately, if possible, wi[h any request made pursuant to this subdivision, or within five days of the date of[he tequest,excluding Saturdays,Sundays and legal holidays,if immediate compliance is aot possible. If he canno[comply with the request wi�hin that time,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure wheu data is not accurate or comp(ete. An individual may contest the accuracy or completeness of public or private data concerning hirnself. To exercise this right,an individual shall nodfy in wriring the responsible authoriry describing the na[ure of the disagreement. The responsible au[horiry shall within 30 days either. (a)correct[he data found to be inaccurate or incomplete and attempt to notify past recipienu of inaccurate or incomplete data, including recipients named by che individual; or(b)nodfy the individual that he believes the data to be correct. Data ia dispute shall be disciosed only if the individual's statement of disagreemen[is included with the disclosed data. The decerminadon of the responsible authonry may be appealed pursuant to the provisions of the administcadve procedure act rela[ing [o contested cases. DaTA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "Ri�hts 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 pe _i-„r ^ JY � � �f /�V —.: ��, Middle Last First i� (/`�C f�� 3 � `�� .,��•�s��''�� Address / � ? / / --� /1�� 1��' i�'��' S� yo?7 ��C� �� Ciry State Zip Phone I unde� d my rights as state� iSo . � � � , ''�� ignature /�