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Sea13.04 RIGHTS OF SUB.TECTS OF D�TA Subd. l. Tvpe 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. An individual asked to supply privatP or confidendal dara conceming himself shall be informed of: (a)the purpose and in[ended use of the requested data within the collecting"state agency,polidcal subdivision,or statewide system; (b)whether he may refuse oY is legally required to supply t2ie requested data;(c)any lmown consequence arising from his supplying or refusing to supply private or confidenrial dara;and(d)the idenriry of other penons or enddes authorized by state or federal iaw to receive the data. This requirement shal] not appty when an individual is asked to suppiy invesrigaave data, punuant to secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of re enue mav place the noace required under this subdivision in the individual income tax or propertv tax refund instructions instexd of on those forms. Subd. 3. Access to data by individual. Upon reque5t to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whe[her it is classified as pub:ic, private or confidendal. Upon his further request,an individual who is the subject of stored private 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[hat data. Afrer an individual has been shown the private data and informed of its meaning,che data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this secdon is pending or addidonal 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 acrual costs of making, 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 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 the individual,and may have an additional 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 conceming himself. To exercise[his right,an individual shall nodfy in wridng the responsible authoriry describing rhe nature of the disagreement. The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to no[ify past recipients of inaccurate or incomplete data, including recipiencs named by the individual; or(b)nodfy 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 auchoriry may be appealed pursuant to the provisions of[he administrarive procedure act reladng to conrested cases. DfyTA 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 pemut or license from the Ciry of Orono or any of its departments may require you to fumish certain private or confidential information. You are notified that: 1. T'h�infc:r^.ati�^.you furnish will be used to deternune your qualification for the permit or license requested. 2, You may refi�se 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 pemut or license. 4. If your requested pemut 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. First Middle Last Address Ciry State Zip one I under tand y rights s ted abov . Signature