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Sec13A4 RIG[iTS OF SUI3JECTS OF DATA Subd. l. 7'ype of data. "I'he rights of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Information required to be given individual.An individual askcd to supply private orconfidential dataconcerning himselfshall be infonned ot: (a)the purpose and intended use of lhe requested data within the collecting state agency,political subdivision,or statewide system;(b) whether he may refuse or is legally required to supply die requested data;(c)any known consequence arising Gom his supplying or refusing to supply private or confidential data;and(d)the identity of other persons or enlities audiorized by sta[e or federal law to receive the data. This requirement shall 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 may place the notice required under this subdivision in the individual income tax or propertv ta�refund instructions instead of on thosc fonns. Subd.3. Acecss to data by individual. Upon request to a responsiblc authority,an individual shall be infonned whether he is the subject of stored data on individuals,and whether it is classified as public,private or contidential. Upon his(urther request,an individua�who is the subject of stored pnvate or public data on individuals shall be shown the data without 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,the data need not be disclosed to him for six months thercafter unless a dispute or action pursuant to this seclion is pcnding or additional data on the individuai has becn collected 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 cosLs of making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possible,with any reques[made pursuant to this subdivision,or�vithin tivc days o(' the date of the request,excluding Saturdays,Sundays and legal hulidays,if immediate compliance is not possible. 1 f he cannot comply with the request within that tiine,he shall so inform the individual,and may have an additional Pive days within which to comply with the request,excluding Saturdays, Sundays and Icgal holidays. Subd.4. Procedure when data is not accurate or comp(ete. An individual may contest the accuracy or completeness of public or private data concerning himself. '1'o exercise this right,an individual shall notity in writing thc responsible authority describing the naturc ofthe disagreement.The responsible authority shall within 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 dispu[e shall be disclosed only if lhe individual's stalement o(disagreement is included with[he disclosed data. The determination of thc responsible authoriry may be appcaled pursuant to the provisions oCthe 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 inform you that your request for a permit or license from the City of Orono or any of its departments may re�uire you to furnish certain private or confidei�tial information. You are notified that: 1. "Che infonnation you furnish will be used to detennine your qualification for the permit or license requested. 2. You inay 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 pennit or license. 4. If your requested permit or license requires Council action to approve,some information may becomc 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. �0;�-'!' � ��%G� .�/�w ,6�E-',�f�E rirst 111iddle Lxst �� s" �/l, wov�t'� ��.-�-� Aaa��s� �' � /�.wl c.� �,�.� �sr`�i � City Statc "l,ip Phone un erstand►ny rights/as stated above. ' /��/l. � Signaturc 32