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� ` Sec.13.04 RIGH'I'S OF SLJBJECTS OF DATA Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be stored shall be as set forth in this secrion. Subd.2. Iaformation required to be given individual. An individual asked to suppiy private or co�denaal data conceming himself shall be informed of: (a)the purpose and incended use of the requested data wi[hin the collecring'state agency, polidcal subdivisio�,or statewide system; (b)whether he may refuse or is leeally required to supply the requestzd data;(c)any lmown consequence arising from his supplying or refusing to supply privace or confidendal data:and(d)the identiry of other persons or entiaes authorized by srate or federai law to receive the data. This requirement shall not apply when an individual is asked to supply invesrigaave data, pursuant to secdon 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of revenue mav place the norice �equired under this subdivision in the individual income tax or propertv tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsibie authoriry,an individual shall be informed whether he is the subject of stored data on individuais, and whecher it is classified as public, priva[e or co�dential. Upon his further request,an individual who is the subjecc of stored private or public data on individuats 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 hun for six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authoriry 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 actual costs of making, certifying, and compiling the copies. The responsible authoriry shall comply immedia[ely, if possible, with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays, if immediate compliance is not possible. If he cannot comply wi[h the reques� within that time,he shall so inform the individual,and may have an addido�al five days within which to comply with the request,excluding Sarurdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or comple[eness of public oc private data conceming himsetf. To exercise this right,an individual shal!notify in writing the responsib(e authoriry dzscribing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correc[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 belizves 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 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 pernut or license from the City of Orono or any of its departments may require you to furnish cenain 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 pernut or license. 3. The information may be shared with other local, state or federal agencies to the e�tent 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. 6. Your full name is required to process this application or permit. �.� r�� 1� � ��r n �,T��- �; - First �fiddle Lasc �`i'��5� �.��i �% Address +4.>c� Zc�� f.� S�� % � y-7� — 7f Y�_� C��S, State Zip Phone I unders[and my rights as stated above. l!��' Sign e