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. Sec.13A4 RIGHTS OF SUBJECTS OF DATA Subd. ]. Type of data. The riehts of individual on�vhom the data is stored or to be stored shall be as set forth in this section. --Subd.2._Infocmation.required_tobegivenindividual.Anindiv.iduaLaske�tasupply_priva[e.or.confidential_dataconceminghimselfshallbe_ _ _. _______ —_. informed of: (a)the purpose and intended use of the requested data within the col lecting state agency,pol itical subdivision,or statewide system;(b) whether he may refuse or is le�al ly required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidential data;and(d)the identity of other persons or entities authorized by sta[e or federal law to receive the data. This requirement sha(i not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue makplace d�e notice required under this subdivision in the individual income tax or propertv ta�refund instructions instead of on those fomis. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuafs,and�ahether it is dassitied as pubfic,private or contidential. Upon his further request,an individual who is the subjec[of stored private or public data on individuals shail be shown the data without any char�e to him and,if he desires,shall be infonned of the content and meaning of that data. After an individual has been shown the private data aiid informed of its meaning,the data need not be disclosed to him for si� months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been col lected 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 authority may require the requesting person to pay the actual costs of making,certifyine,and compilin�the copies. The responsible authority shall comply inunediately,if possible,�vith any request made pursuant to this subdivision,or within five days of the date of d�e request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he ca�mot comply with the request within that time,he shall so inform the individual,and may ha�-e an additionaf five days within which to comply with the request,excludi��g 3aturdays, Simdays and legal holidays. Subd.4. Procedure when data is notaccurate orcomplete. An individual may contest the accuracy or completeness of public or private data concerning himself. To e�ercise this right,an individual shall notify in writing the responsible authoriry describing the nature ofthe disagreement. The responsible authority shall wid�in 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients 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[he individual's statement of disagreement is included with the disclosed data. The determination of the responsible authorit}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 infonn you that your request for a pern�it 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 inforn�ation you furnish will be used to detern�ine 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 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. i� �-�� ----- ` � � C�uc��'S �z;�.Ksa v '� First �Iiddle Last `�1 ,Z- C-�t `I� Address � ` - � (� ��3�7 � �� Cih State 'Lig Phone I u derst my rights as st ted abo . • �,. Sigm urc j?