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/ + M• • Sec.13.04 RIGHTS OF S[1BJECTS 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 secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or co�dendal data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting"state agency,political subdivision,or statewide system; (b)whether he may refuse oY is legally tequired to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidenrial data;and(d)the idendty of ocher persons or enrides authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to suppty invesdeauve data, pursuant ro secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav place the notice reouired under this subdivision in the individuai income tax or propertv tax refund instructions ins[ead of on those forms. Subd. 3. Access to data by indiriduai. Upon requesc to a responsible authoriry,an individual shall be informed whether he is the subject of scored data on individuals, and whe[her it is ciassified as public, priva[e 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 wi[hout 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 thereafter unless a dispute or accion pursuanc to [his secdon is pending or addidonal data on�he individual has been col(ected 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 cosu of making, certifying,and compiling the copies. The responsible authoriry shall comply immediately, if possible, wich 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 ticne,he shall so infornt the individual,and may have an addirional 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 this rieht,an individual shall norify in wridng the responsible authority describing the nature of the disagreement. The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to norify past recipienu of inaccurate or incomplete data, inciuding recipients named by the individuai; or(b)notify the individual[hat he believes the data[o be correct. Dara in dispute shall be disclosed only if the individual's statement of disagreement is induded with the disclosed data. The determination of the responsible au[horiry 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 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 permit 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 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. << � , �, ��-:�--, �� -� o_� ��'� ' First �� '\ � .. � Middle Last �� 1 � _ ,� � � � � (� y _ Aa�ss �� \ � _� C'" � ,� �=;�•,,� \_ �- �� _'�� '1 . �� , _�- � �� �� " � State Zip Phone I understand my right� stated above. -� �, ^ � � � ;��' ��.l_ '��l ��s-� ��- � -� . _ � Signamre \ -_____