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Sec.13.04 RIGH"TS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set for�h in this secdon. Subd.2. Information required to be given indiridual. An individual asked to supply private or confidenaal data concerning himself sha11 be informed of: (a)the purpose and incended use of the requested data wi�hin the collecdng'srace ageocy, polidcal subdivision,or statewide system; (b)whether he may refuse or is leeally required to supply the requested data;(c)any Imown consequence arising fmm his supplying or refusing to supply private or confidenaal data;and(d)the idendry of o[her persons or entides authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to suppiy invesdgaave dara, punuant to secrion 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav place [he noace required under this subdivision in the individual income tax or properev tax refund instrucrions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whe[her he is the subjec[ of stored data on individuals, and whe[her it is classified as public, private or co�den[iai. Upon his futther 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 contenc 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 secaon is pending or addidonal data on the individual has been collected or creaced. The responsible authoriry shall provide copies of the privace or public data upon reques[by the individual subject of the data. The responsible authoricy may cequire the requesting penon to pay the actual coscs of making, cercifying, 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 reques[ within that tune,he shall so inform the individua(,and may have an addidonat 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 accumcy or completeness of public or private data conceming himself. To exercise[his right,an individual shali notify in writing the responsible authoriry describing the nature of the disagreemen[. The responsible authoriry shalt within 30 days either: (a)correc[[he data found to be inaccurate or incomplete and attempt to noafy past recipiencs of inaccurate or incomplete data, including recipients named by the individual;or(b)notify the individual tha[he believes the data to be correct. Data in dispute shall be disclosed only if the individual's s[atement of disagreement is included with the disclosed data. T'ne determination of the responsible authoriry may be appealed pursuant to the provisions of the administrarive 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 furnish will be used to determine your qualification for the permit or license requested. 2. You may refuse to suppiy data, but refusal may require that the City deny the permit or license. 3. The information may be shared with other local, sta[e 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. .-- � �'' /�� ,-c- /{ C�,L �11 l( (�`G� <<r C 1'T �f� ' �= First `tiddl � Last l C� �,� ��l� 1i�<< � L- � h ��c' � Address ,�! � � ,, ! 5 ��'"�� / , � z� - �9 1 �- j jL� � �i �, � �7 �,_ �i ! C�ty State Zip Phone I understand my rights as state� above. �'C�z---- �/ --' Signature