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Sec.13.04 RIGHTS OF SUB.TECTS OF D�Ta ` Subd. 1. Type of data. The righrs of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Informarion reqirired to be given individual. An individual asked to supply private or confideaaal data concerning himself shall be informed of: (a)the purpose and intended use of the requested data wirhin the collecang'state agency,poliacal subdivision,or statewide system; (b)whether he may refuse oY is legally requiced to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply private or confidenrial data;and(d)the idenary of ocher persoas or enrides authorized by state or federal law to receive the data. This requ'uemenc s6a11 not apply when an individual is asked to supply invesdeaave dara, punuant to section 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of re�•enue mav place the notice reauired under this subdivision in the individual income tax or oropem tax refund instructions instead of on those forms. Subd. 3. Access to data by indi��dual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuais,and whe[her it is classified as public, private or confidendal. Upon his further request,an individual who is the subject of stored private or public dara on individuals shall be shown[he data wi�hout any charge to hicn and, if he desires, shall be informed of the content and meaning of chat data. After an individual has been shown[he privace data and informed of its meaning,the da[a need not be disclosed to him for six mon[hs thereafter unless a dispute or acrion pursuanc to this secrion is pznding or addidonal data on the individual has been coilecced or created. The responsible auchoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesring person to pay the actual costs 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 request,excluding Sarurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within�hat time,he shall so inform the individual,and may have an addirional five days within which to comply with the request,exclLding 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 priva[e data concerning himseif. To exercise this right,an individual shall nodfy in wri[ing[he responsible authoricy describing�he nature of the disagreement. The responsible authoriry shall within 30 days either. (a)coaect the data found to be inaccutate or incomplere and attemp[to norify past recipients of inaccunte or incomplete data, including recipients named by the individual;,or(b)notify the individual that he believes the data to be correct. Data in dispuce shall be disclosed only if[he individual's statement of disa;reement is included with the disclosed data. Tlie determinarion of the rzspensible authoriry may be appealed pursuant to the provisions of the administrarive procedure act relacing to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "Ri�hts of subjects of data", we would like to inform you that your request for a permi[ 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 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 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 permi[ 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 �'�Or�\ �^c c-� �� C� �� - Fi �tiddle Last � y1� C.� e��C�•�..�.:� �� Address '��r� ��,V jC>j5�c L�;��'r ��``I L- Ciry State Zip Phone I und rstand my rights as stated above. \ g ��v� Signature