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,.� �. Sea 13.04 RIGHTS OF SUB.TECTS OF DAT� Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. .4n individual asked to supply private or confidendal data conceming himself shall be informed of: (a)the purpose aud in[ended use of the requesced dara wichin che collecting'state agency,poliacal subdivision,or statewide rystem; (b)whe[her he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or co�dendal data;and(d)the identity of ocher persons or enrides authonzed by state or federal law ro receive the data. This requirement shall not apply when an individual is asked to supply invesrieadve dara, pursuanc ro secdon 13.82, subdivision 5, to a law enforcemen[officer. The commissioner of re�enue mav ptace the nodce reauired under this subdivision in the individual income tax or_propertv tax refund instructions ins[ead of on those forms. Subd. 3. Access to data by individual. Upon reques[to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals, and wherher it is classified as public, private or confidenaal. Upon his further request, an individual who is the subjecc of stored private or public data on individuals shall be shown che data wichout any charge to him and, if he desires, shall be informed of the content and meaning of that data. Afrer an individual has been shown the private data and informed of its meaning, the data need not be disclosed to hun for six months[hereafter unless a dispute or acaon pursuant to this section is pending or addiaonal data on the individual has been collected or created. The responsible au[horiry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the acrual cosu of making, certifying, and compiling the copies. The responsiblz authority shall comply immediacely, if possible, wi�h any request made pursuant co this subdivision, or within five days of the date of the request,excluding Saturdays,Sundays and leeal 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 with[he request,excluding Saturdays, Sundays and le¢al holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data conceming himself. To exercise this rieh[,an individual shall norify in wricing the responsible authority describing the nature of the disagreement. The responsible authoriry shall within 30 days either. (a)correct the data found ro be inaccurate or incomplete and attempc to norify past recipients of inaccurate or incomplete data, includin¢ recipients named by the individual; or(b) notify the individual that he believes the data ro be correct. Data in dispute shall be disclosed only if[he individual's statement of disagreement is included with the disclosed data. The decerminacion of the responsible authoriry may be appealed pursuant to the provisions of the administraave procedure act relaang to contested 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 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 pemut 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 pernut 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. (. Your full name is required to process this application or permit. �7 / �7 1_ �'� ��% �> � ` � � Las[ � First Middle �'% ' � /�`/ '�//`—� �/ �/i" i Addres � � �/ � > > %�' � � �/:7�—��,`/ c T �'� f : �: -, City State Zip Phone I understand my n�}�ts as stated above. �" - - - / , � � , � _ -- �/� ✓- /- ;, ;�� �- � Signature