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-� - Sec.13.04 RIGHTS OF SUB.TECTS OF DATA Subd. 1. Type of data. The rights of iadividual on whom the data is stored or to be stored shall be as set forth in this secrion. Subd.2. Information reqirired to be given individual. An individual asked to sapply private or confidendal data conceming himself shall be informed of: (a)the purpose and inunded use of the requested data wichin the collecting�tace agency, poliacal subdivision,or stacewide symm; (b)whether he may refuse or is legally required to supply the requested data;(c)any l�own consequence arising from his supplying or refusing to supply private or confidenoal dara:and(d)che idenriry of other persons or entiaes authorized by state or federal law to�eceive the data. This requirement shall not apply when an individual is asked to supply invesagarive dara,pursuant to secrion 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav lace the noace re uired under this subdivision in the individual income tax or rooertv raz refund inscrucdons instead of on chose forms. Subd. 3. Access to data by individual. Upon reques[to a responsible auchoriry,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 dara on individuals shall be shown the data wi[hout any charge to him and, if he desires, shall be informed of the content and meaning of that dara. Afrer an individual has been shown[he private data and informed of ics meaning,the data need not be disclosed to him for six monchs thereafter unless a dispute or acaon pursuant to this secrion is pending or addiaonal data on the individual has been collected or creaced. The responsib(e authoriry shall provide copies of the private or public data upon request by[he individual subject of the data. The responsible au[horiry may require the requesdng person to pay the actual cosu of making, certifying, and compiling the copies. The responsible auchority shall compiy immedia[ely, if possible, with any request made pursuant to this subdivision,or within five days of the date of the request,ezcluding Sacurdays,Sundays and legal holidays,if immedia[e compliance is no[possible. If he cannot comply with the reques[ within that time,he shall so inform[he individual,and may have an addidooat five days within which to comply with the request,excluding Satucdays, 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 himself. To exercise this right,an individual shall nocify in wnting the responsible au[horiry describing the nature of the disagreement. The responsible authority shall wichin 30 days either: (a)correct the data found to be inaccunte or incomplece and attempt to noafy past recipients of inaccurare or incomplete data, including recipiencs named by the individual; or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statemen[of disagreement is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the administradve procedure act relacing to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data", we wouid like to inform you that your request for a pernut or license from the Ciry of Orono or any of its departments may require you to fumish certain 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. Z, You may refuse to supply 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 extent necessary to process the permit or license. 4. If your requested pernut or license requires Council action to approve, some information may become public. j. 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. � ��Gc�l�— � . V�'�'��? � F�� iddle / Lasc �� Aaa�s �� / `(/l� 5�� / �?�— � 7 �� U�� State Zip Phone Ciry I understan� s �ta �ove. , � � Signacure