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� . Sec.13.04 RIGH"TS OF SUBJECTS OF DATA Subd. 1. Type of data. The righrs of individual on whom rhe data is stored or to be sto�ed shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to suppiy privatE or confidenrial data concerning himself�►+atl be informed of: (a)the purpose aad inunded use of the requested data within the collecring'state agency,polidcal subdivision,or starewide system; (b)whether he may refuse or is legally requued to supply the requested data;(c)any known consequence arising from his supplying or cefusing to suppiy private or co�denaal data;and(d)the idennry of o[her persons or endries authorized by state or federal law to receive the data. This requirement chali noc apply when an individual is asked to supply invesrigaave dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. 'Ilie commissioner of revenue mav lace the nodce re uired under this subdivision in the individual income taz or rooem tax refund instrucrions instead of on-chose forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whe[her he is the subject of stored data on individuals,and whether it is classified as public, priva[e or co�denrial. Upon his further request,an individual who is the subjecc of stored•private oL.public dara on individuals shall be shown the data without any charge to hicn and,'if he desires, shall be informed of the contenc and meaning of that data. Afcer an individual has been shown the private c�ata.and informr�d qf its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this secdon is pending or addidona7 dara on�ttle'individual bas been collected or created. The resp'oqsi�ile auchoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible au[horiry may require the requesdng penon to pay the'aCtual cosu of making, certifying,,and o-ompiling the copies� The responsible authoriry shall comply immediately, if possible, with any request made pursuant fo this subdivision,or within five days of the date of the requesc,excluding Samrdays,Sundays and legal holidays,if immediate compliance is not possible. If he canno[comply with the request within that time;hC shall so inform r�e individual,and may have an addirional five days within which to comply with the request,excluding Saturdays, Sundays and leg�holid�ys. � ; • . > . - _ � • •5ubdr4. Procedure when data is not accurate or complete. An individual may contest the accuracy or compteteness of public or private data conceming himself. To exercise Q�'rs�right,an�ndividual shall norify in wridng the responsiple authon�Y describing the nature of the disagreement. The responsible authoriry shall within 30 days ei[her. (a)correct the data found to be inaccurate or incoa}ple�and attempt to norify past recipiencs of inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individua7 that e 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 authoriry may be appealed pursuant to the provisions of the adminisuadve 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 Ciry of Orono or any of its departments may require you to furnish cenain private or confidential information. You are notified that: `�''�' i, ,'`'''�1'he information you furnis'1hwilLbe used ta c�teru}ine your qualification for the permit or license requested. 2. You may refuse 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 permit or license.• � 4. If your requested perm.it'or license requires Council action to approve, some infoimation may become public. ' �. You have certain rijhts under M.S. 13.04 (available upon request) to review private data on yourself. 6, Your fiiTl riarp��is required to process this application or permit. �j�•�s�• �.s� �. c � oS Firsc �. ;viiddle Last i � Address I v / In1G•,i a.�, �rn n/ SS' 3 a/ � o Ciry�— State Zip hone • ;_ �f . I under tand my rights as stated above. � s� _