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w Sec.13.04 RIGHTSOFSUBJECTSOFDATA Subdivrsion/. Type ojdata. The rights of individual on�vhom the data is stored or to be stored shul!be as set forth in this sectron ` Subd.2. Injormation required to be given individuaL An indrvidua!asked to supph private or confidential data concerning'�hrmselj shall be rnformed of' (a)the purpose and intended use of the requested data within the collecring state agency,political subdivision,or statewide system;(b)whether he may rejuse or is legolly required to supply the requested data;(cJ arry�knotivn conseqaence arising from his supplyrng or refusing to supply private or confrdential data;and(dJ the identity of other persons or entitres authori�ed by state or federal!mv to recerve the data This requirement shall not apply when an indivrdual is asked to supply investigalive data,pursuant to sechon 13.82, subdivisron 5, to a!aw enforcement o�cer. The commissioner of revenue may place the notice requrred under this subdivrsion rn�he rndn-idual rncome tac ar property tax refund instructions�nstead of on those forms. Subd.3. Access to data by individuaL Upon request to a responsible authority,an rndn idual shall be informed ti��hether he is the subject of stored data on indrvrduals, and whether rt is classifred as public,private or confrdentral. Cpon hrsfurrher request,an individual ivho is the subject oJstored private or public data on rndividuals shall be shown the data without any chcrge to hrm mrd rf he desr�es,shall be rnformed of the content and meaning of that data. After an indrvidua!has been shoivn the prrvate data a�rd informed of iu meaning, the data need not be drsclosed to hrm for srx monlhs thereafter unless a dispute or action pursuant!o this section is�nding or additional data on the individual hvs been collected or created. The responsible authorrry shall provide copies of the private cr pubirc data uport request by the indivrdua!subject oJ the data. The responsible authority may requrre the requesting person to pay the actual costs ai making, cernfj•ing,and compiling the copies_ The responsible authorrty shal!comply immediately,if possib/e,with any request mc.^,2 pursucrs to thu subdrvision,or within five da}s a.f'the date of the request,excluding Saturdays,Sundays and legal holidays,if rmmediate compl:�nce rs not possible. If he cannot comply with the request within that time,he shall so rnjorm the individual,and may have an additional five days}��thrn wh:ch to camply ivrlh the request,excluding Saturdays,Sundays and lega!holidays. Subd.4. Procedure when data is not accurate or complete.An rndivrdual may conrest the accurac�•or complereness ofpublrc or private data concerning himself. To exercise this right, an rndrvrdua!shall notrfy in writing the responsible aurhority descrrbing the nature ojthe disagreement. The responsrble authorrty shall within 30 days erther: (a)correct the dataJ'ound to be rnaccurate or incomp(ete and attempt to not� past recrprenls of inaccurate or incomplete data,including recipients named by the individual:cr/b)notlfi the individual that he believes the datn to be correcr. Data in drspute shall be disclosed only rf the individua!'s statement ojdisagreement rs inclndzd x ith the disclosed data. The determinatron of the responsible authority may be appealed pursuant to the prm uions of thz a�ninistratn e procedure act relating to contested cases. DATA PRIf�ACYADVISORY /naccordancewithMS.13.04,Subd.2, "RrghtsofsubjectsoJdata",tivewouldliketo;nfarmyouthatiourrequestforapermitorlrcerese j'rom the City of Orono or any ojits departments may require you to furnrsh certain private or confrdent:el information. You are notified that: 1. The information you furnish will be used to determine your qualifrcahar,''or the permit or Gcense req:rested. 2. You may refuse to supply data, but refusal may require that!he Crty dem the permzt or license. , 3. The information may be shared with other loca/,state or federal agencies to the er'.znt necessary ro process the permiJ or license. 4. If your requested permit or license requrres Council actron to approve.same rnjormatron may become publre. 5. You have certain rrghts under M.S. l3.04(see following pageJ to revie�c prn•ate da:a on�ourselJ 6. Your full name is required to process this application or permit. PLEASE PRINT �red r�►-�e� T� I�ns�►-� Frrst dfiddle Last 3�3�� oL�-nT y IZ�.I �-i�I Address Y�`1I �'l4'1�fv�t S�C,� (l�lrv �5 3�� I �Ia-�lC l-5 I��} C�ty State Zip Phone I un rst'nd rig as stated above. Signat 10