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� � Sec.13.04 RIGHTS OF S[JBJECTS OF D�1TA Subd. 1. Type of data. The riehts of individual on whom the data is stored or[o be stored shall be as sec forth io this secaon. Subd.2. Information required to be given individual. An individual asked to supply private or confidenaal data concerning himself shall be informed of: (a)the purpose and in[ended use of the mquested data within the coliecting"state agency, poliacal subdivision, or statewide system; (b)whe[her he may refuse oY is legally required to supply the requested data:(c)any known consequence arising from his supplying or refusing to supply private or confidential data;and(d)the idencity of o[her persons or endries authorized by state or federal taw to receive the data. This requirement shall not apply when an individual is asked to supply investieaave data, pursuan[to secaon 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav place �he nodce reouired under this subdivision in the individual income tax or propertv tax refund R, instructions instead of on those forms. Subd. 3. Access to data by individual. Upon request 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 public, private or confidenaal. 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 hun and, if he desires, shall be informed of the content and meaning of that data. After an individual has been shown[he privace data and informed of its meaning, the data need no[be disclosed to him for six months thereafter unless a dispute or acrion pursuan[to this section is pending or addidonal dara on the individual has been collected or created. The responsible authoriry shall provide copies ot the private or public data upon request by the individual subject of[he data. The responsible authoriry may require [he requesting person to pay the actual cosu 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 reques[,exduding Saturdays,Sundays and leeal 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 addiaonal five days within which to comply with the request,excluding Saturdays, Sundays and le¢al holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or privare data concerning himself. To exercise this right,an individual shall notify in writing the responsible authori[y dzscribing the nature of the disagreement. T'he responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to norify past recipients of inaccurate or incomp(ete data, including recipients named by the individual; or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disetosed only if[he 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 administrarive procedure act reladng to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "Riahts 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 pernut 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 permit 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. �� �.' - �:� i�'�-� i �n 4~ First Middle st 1 � Address ��l� ��,,, ��: C�ry � State ip Phone I underst�nd rights as stated above. � �_ � Signa[ure