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.� � Sec.13.04 RIGHTS OF SLB.TECTS OF D�T� Subd. 1. Type of data. The nehrs of individual on whom che data is scored or to be stored shall be as sec toczh in this secdon. Subd.?. Information required to be�ven individual_ .�n individual asked w supply priva[e or coni�denaal dara concerrung himself shall be informed of: (a) the purpose and in�er,ded use of the requested data within[he collecting'stace agency, polidcal subdivision, or stacewide system; (b)whe�her he may refuse or is legally required ro supply che requested dara:(c)any Irnown consequence arising from his supplying or refusing to suppty priva[e or contidenoal data;and(d)the idendty ot other persoas or entides au[horized by state or federal law to receive the data. This requirement shall no[apply when an individual is asked to supply invesn2adve dara. pursuant to secnon 13.82, subdivision�, to a law eniorement oiiicer. The commissioner oi rever.ue mav olace :he r.odce reauired under chis subdivision in [he individual ir.come raz or orooem tax refund instructions ins[ead ot on [nose iorms. Subd. 3. Access to data by individual. Uoon reques[[o a responsible authonry,an individual shall be iniormed whether he is the subject of stored data on individuals, and whecher i[is classined as puolic, pnva[e or conridennal. Upon his fur[her request, an individual who is the suojecc of stored priva[e or public data on individuals shall be shown [he data wichout any char,e ro him and, if he desires, shall be informed of[he content and meanin;of tha[da[a. .-�fter an individual has been snown[he priva[e data and informed of ics meaning, che data need noc be disclosed to hun for six months thereatter unless a dispute or action pursuan�co this secaon is pending or addiaonal data on the individual has been collected or creaced. The responsiole auchonry shall provide copies of che prn a�or pubiic data upon reauest by[he individual subject oP the data. The responsible authority may require [he requesrine person to pay the actual costs of makin3, cemryine, and compiling the copies. The responsible authori[y shall comply immedia[ely, if possible, with any request made pursuant to this subdivision, or wirhin five days of the dace of the requesc, excluding Saturdays,Sundays and legal holidays,if immediare compliance is no[possible. If he cannoc comply with[he request within tha[time,he shall so iniorm the individual,and may have an additional five days within which to comply wich rhe request,excluding 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 private data conceming himseif. To exercise�his rieh[,an individual shall notify in wri[ing[he responsible au�horiry describing che nacure of the disagreement. The responsible auchonry shall within�0 days ei[her. (a)correct the data found ro be inaccurate or incomplete and attempt to nodfy past recipiencs of inaccurate or incomplete data, inciudine recioiencs named by [he ir.dividual: or(b) nodfy the individual tha[he believes the data ro be correct. Data in dispute shall be disclosed only if the individual's sta�emenc ot"disagreement is included wi[h the disclosed data. The de[ermination of the responsible au[honcy may be aopealed pursuant ro �he provisions o[rhe admuusaadve procedure act relacing to contested cases. D:�T:� PRIV�,CY 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 depanments may require you to fumish certain private or confidential information. '.'ou �e :.�tif:ed thac: 1, The information you furnish will be used to de�ermine your qualification for the permit or license requested. 2 You may refuse to supply data, but refusal may require that the Ciry deny the permit or license. 3. The information may be shared with o[her local, state or federal aQencies to the extenc necessary to process the permit or license. 4. If your requested pernut or license requires Council accion to approve, some information may become public. �. You have certain rights under �f.S. 13.04 (available upon request) co review private data on yourself. 6, Your full name is required co process this applicacion or permit. �� <�.� � First l�fiddle Last l��1 v �� L Sl v ,� �L�'1? Address �' ��•� � � J (�� "�� / � ST�� Ciry State Zip Phone I understand rights as s ated above. � ��^\ � Sienature