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..�- : Sec.13.04 RIGHTS OF SUBJECTS OF DAT?� Subd. 1. Type of data. The righCs of individual on w6om the data is stored or to be stored shall be as se[forth in this secdon. Subd.2. Information reqirired to be�ven individual. ,�.n 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'stace ageocy, po(irical subdivision, or stacewide system; (b)whecher he may refuse or is legally required to supply the requested data:(c)any lmown consequence arisiflg from tvs supplying or refusing co supply private or confidendal data;and(d)che idenary of ocher persons or enades authorized by state or federal law to receive�he data. This requirement shall not apply when an individual is asked to supply invesdgadve dac�t, pursZtant to secdon 13.82, subdivision 5, to a law enforcemen[o�cer. The commissioner of revenue mav place the noace required under this subdivision in the individual income rax or orooem raz refund instrucrions instead of on[hose forms. Subd. 3. Access to data by individual. lipon request to a responsible auchoriry,an individual shall be informed whether he is the subject of stored data on individuals, and wherher it is classified as public, private or contidendal. Upon his fur[her request,an individual who is the subjec� of stored private or public data on individuals shall be shown thz data wichouc any charge to him and, if he desires, shall be informed of the content and meaning of[hat data. Afrer an individual has been shown[he priva[e dara and informed of i[s meaning, [he daea need no[be disclosed to him for six months chereafter unless a dispure or acdon pursuanc ro this secaon is pending or addidonal data on the individual has been collected or created. The responsible authoriry shall pro�ide copies of the private or pubiic data upon request by[he individual subject of the data. The responsible authoriry may require the requesdng person to pay che accual costs of making, cerrifying, and compiling che copies. The responsible authoriry shall comply immediate(y, if possibie, wich aay request made pursuant to this subdivision, or wi[hin five days of the date of the request,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is no[possible. If he cannot comply wich the requesc within that time,he shall so inform the individual,and may have an addidonal five days wi[hin which to comply with the request,excluding Saturdays, Sundays and legat holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accucacy or completeness of public oc private data conceming himself. To exercise[his right,an individual shail noafy in wriang the responsible authoriry describing the nature of the disagreement. T'he responsible au�horiry sha11 wirhin 30 days either: (a)correcc the data found to be inaccurace or incomplete and attempt to norify past recipients of inaccurate or incompfete data, including recipients named by che individual; or(b) nodfy the individuai that he believes the data to be correct. Data in dispute shali be disclosed only if che individual's statement of disagreement is included with the disclosed data. The de�ermination of the responsible au[hority may be appealed pursuant to the provisions of the administradve procedure act relaang to con�ested 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 City of Orono or any of its departments may require you to furnish cenain 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 supply data, but refusal may require chat the City deny the perm.it or license. 3. The information may be shared with other local, state or federal a�encies to the extent necessary to process the permit or license. 4. If your requested perm.it or license requires Council action to approve, some information may become public. 5. You have certai.n 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. � � � � � �� F�� Middle Last � � ��''s� �i�t-� � Addres p �� 'c �f'�/�� c �� O ��' � Ci�, � State Zip Phone �_ I understan my rights��stated a � e. /� � �;�%'� � ,�_ ✓(,'l�� � ��,1�� Signacure