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� Sec.13.04 RIGHTS OF SLlB.TECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as sec forth in this secaon. Subd.2. Information required to be given individual. An 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 collecring'state agency, polidcal subdivision,or sta[ewide system; (b)whether he may refuse or is legally required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply private or confidenaal data;and(d)[he idenary of other persons or endaes authorized by stace or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesagaave data, pursuant to secrion 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of revenue mav place the norice required under this subdivision in the individual income tax or propem 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 whether he is the subject of stored data on individuals, and whe[her it is classified as public, private or co�dential. Upon his further request, an individual who is the subject of stored private or public data on individuals shall be shown the data wichout any charge to hirn and, if he desires, shall be informed of the content 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 secrion is pending or addidonal data on the individual has been coflected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the accual costs of making, certifying, and compiling the copies. The responsible authority shall compty immedia[ely, 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 noc possible. If he cannot comply with the requesc within that time,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,excluding Sacurdays, 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 private data concerning himsetf. To exercise this right,an individual shall notify in wri[ing the responsible authority describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of inaccurate or incomplete data, including recipients named by the individuat; or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if[he individual's statement of disagreement is included with the disclosed data. The determina[ion of the responsible authoriry may be appealed pursuant to the provisions of the administntive procedure act relacing 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 determuie your qualification for the permit or license requested. 2. You may refuse to suppiy data, but refusal may require that the City deny the pernut or license. 3. The information may be shared with other local, state or federal agencies to the e�tent 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. (. Your full name is required to process this application or permit. � /'� C.t.�r�c� C� � � ��u-��r�S�'� First n �tiddle� Last ��1'J l ,riu 5� t�.� � \`-�. A ress ��; � �111� �� I �� 1 -� 531 C�ry State Zip Phone I nde stand my rights as stated above. . C, ` � � Signature