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� Sec.13.04 RIGHTS OF SUBJECTS OF DaT?� Subd. 1. Type of data. The righcs of individual on whom[he data is stored or to be stored shall be as set focth in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confideorial dara concerning himself shall be informed of: (a)the purpose and in[ended use of the requested dara within the collecdng"statE agency,poliacal subdivision,or sratewide rystem; (b)whether he may refuse or is legally requiced[o supply the requested data;(c)aay Irnown consequence arising from his supplying or refusing to supply • privace or confidendal data;and(d)the idenriry of other persons or enrides authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesrieadve dam, pursuan[to section 13.82,subdivision 5, to a law enforcemenc o�cer. - The commissioner of revenue mav place the norice reauired under[his subdivision in the individual income tax or prooem tax refund instrucrions inscead of on chose forms. Subd. 3. Access to data by individual. Upon requesc to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and wherher it is classified as public, private or confidenrial. Upon his further request, an individual who is the subjec� of stored private or public daca on individuals shall be shown[he data wichout any charge to him and, if he desires, shall be informed of the contenc and meaning of chat data. After an individual has been shown che privace data and informed of its meaning,the data need not be disclosed to him for six mon�hs thereafter unless a dispute or acdon pursuanc to this secdon is pending or addidonal data on the individual has been co(lected or creaced. The responsible authority shall provide copies of the private or public data upon request by the individual subject of che data. The responsible authoriry may require the requesting person to pay the actuai costs of making, cerufying,and compiling the copies. The responsibie au[horiry shall comply immedia[ety, if possible, with any request made pursuant to this subdivision,or wi[hin five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform[he individual,and may have an addirional five days within which to comply wi[h the request,exciuding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may conrest the accuracy or completeness of public or private data conceming himself. To exercise�his right,an individual shall noafy in wricing che responsible auchoriry describing the nacure of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the dara found to be inaccurate or incomplete and attempt to noafy past recipients of inaccunre or incomplete dara, including recipients named by the individual; or(b)noafy the individual thac he believes the data to be correc[. Data in dispu[e shall be disclosed only if the individual's statement of disagreement is included with the disctosed data. The de[erminarion of the responsible authoriry may be appealed pursuant to the provisions of che admirustradve procedure act relating to contesced 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 pernut 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 perm.i[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 applica�ion or permit. �� 1-ac,.�'/ > l"��r��T First �tiddle Lasc �� / � �/t!✓li��'W� � vT �� J Address_ ��`/ /L/� �� /� S/ �1� / �''I/"7� Ciry Stare Zip Phone iJ I underst 'my ri�hts as state ove. — , ` �' \.�-:. Sign