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r �, Sec.13.04 RIGHTS OF SLJB.TECTS OF DATA Subd. i. Type of data. The rights of individual on whom the data is stored or co be stored shall be as se[forth in this secrion. Subd.2. Information reqtrired ro be given individual. �.n individual asked to suppty private or confidendal data co�ceming himseif shall be informed of: (a)the purpose and in[ended use of the requested dara wirhin the collecting'state agency, political subdivisio�, or statewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidenrial data;and(d)the identiry of other persons or enrides auchorized by state or federal law to receive the data. This requiremeot shall not apply when an individual is asked to supply invesdeadve data, pursuant to secdon 13.82, subdivision 5, to a law enforcement ofFicer. The commissioner of re�enue mav place the norice reauired under this subdivision in the individual income tax or propertv tax tefund instructions instead of on those forms. Subd. 3. Access to data bv individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of scored data on individuals, and whecher it is classified as public, private or confidenrial. Upon his further request, an individual who is the subjec� of stored private or public data on individuals shall be shown[he data wi[hout any charge to hun and, if he desires, shall be informed of the content and meaning of that data. After an individual has been shown the privace data and informed of irs meaning, che data need not be disclosed to hicn for six months[hereafter unless a dispure or acrion pursuanc co chis secdon is pending or addirional data on the individual has been collected or crea[ed. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of[he data. The responsible authoriry may require the requesting person to pay the actual cosu of makine, certifying, and compiling the copies. The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision,or within five days of the date of[he request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is noc possible. If he cannot comply wi[h[he request within that time,he shall so inform the individual,and may have an addiaonal five days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this rieht,an individual shall notify in writing 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 attempt to nodfy past recipienu 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 the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act reladne to 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 pemut 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. � ,��r�� '� f, ;�,�� / �- First �iid,d� Last ��l� /�? �� !�(,�' /��r �A ress ' r�= i r_, i - � .- /�%-' �'�y''�t�l�/'I�i� �,/�/ �� .� �,�� 06� Ciry State Zip Phone I understand my rights as stated above. �� C_,C�i- l�.i��%t G' Signatu