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� Sec.13.04 RIGHTS OF SUB.TECTS 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 fonh in this secdon. Subd.2. Information required to be given individual. M individual asked to supply private or confidendal data concerning himself shall be informed of: (a)the purpose and incended use of the requested data within the collecting'state agency, polidcal subdivision,or sta[ewide system; (b)whether he may refuse or is leeally required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply private or confidendal data;and(d)the idenary of other persons or enriries authorized by state or federal law to receive the data. This requirement shall not apply when an individuai is asked to supply invesrigarive data, pursuant to secrion 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav place the noace required under this subdivision in the individual income tax or propertv tax refund instrucrions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible au[horiry,an individual shall be informed whe[her he is the subject of stored data on individuals,and whe[her it is classified as public, private or co�dendal. 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 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 action pursuant to this secrion is pending or addiaonal data on the individual has been 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 authoriry may require the requesting person to pay the actual coscs of making, certifying, and compiling the copies. The responsible authority shall comply immediately, if possible, with any request made pursuant to this subdivision, or within five days of the date of the request,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply wi[h the request within that time,he shall so infornt the individual,and may have an addidonal five days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure�vhen data is not accu:ate or complete. An individual may contest the accuracy or completeness of public or private data conceming himself. To exercise this right,an individual shall notify in wricing the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either. (a)correc[the data found ro be inaccurate or incomplete and attempt ro nodfy past recipieou of inaccurate or incomplete data, including recipients named by the individual; or(b)notify ihe individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's sta[ement of disagreement is included with the disclosed data. Tne determination of the responsible authoriry may be appealed pursuant to the provisions of the administracive 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 certain private or confidential information. You are notified that: 1. The information you fumish will be used to deternune your qualification for the pemut 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 extent necessary to process the pemut 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. ___�-..0 l�l t\; �i�.,�,��4�:z 1;� ��'C_'7_ First \M'ddle Lasc 7 � ��, ` �C'j��'(f=�2 V d�+�� — Add� � �,ti� �,�"(�c�� M�, �-�?� (P C�ty � State Ztp Phone ;--`� / I understand my ' ts as stated above. , f � . n3ture' � ��