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e y Sec.13.04 RIGHTS OF S[JB.]ECTS OF D�TA Subd. 1. Type of data. The righ[s of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information required to be given individual. An individual asked to supply private or confidendal dara conceming himself shall be informed of: (a)the purpose and in[ended use of the requesred dara within the collecting'state agency,political subdivision,or sratewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any Irnown consequence arising from his supplying or refusing to supply private or confidenaal data;and(d)the idenriry of other persons or enades authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesrieaave data, pursuan[to secdon 13.82, subdivision 5, to a taw enforcement officer. The commissioner of re�enue mav place the nodce reauired under this subdivision in the individual income tax or prop_e__m tax refund instructions instead of on those forms. Subd. 3. Access to data by individuai. Upon reques[to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and wherher i[is classified as public, private or confidendal. Upon his further request, an individual who is the subject of stored private or public data on individuals shall be shown[he data without any charge to him and, if he desires, shall be informed of the content and meaning of chat data. After an individual has been shown the private data and informed of ics meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acdon pursuanc to this secrion is pending or addiaonal data on the individual has been collected or created. The responsible authoriry 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 acrual costs of making, certifying,and compiling the copies. The responsibie authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision,or within five days of the date of the request,exctuding Sarurdays,Sundays and legal holidays,if immediace compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addiIIonal five days within which to comply with the 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 himself. To exercise[his rieht,an individuai shali notify in wridng the responsible authority describing�he nacure of the disagreement. The responsibte authoriry shal(within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of inaccurate or incomplete data, including recipients 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 statement of disagreement is included with the disclosed data. The decerminarion of the rtsponsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act relating 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 permit 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 determine your qualification for the pemut or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the pemut or license. 3, The information may be shared with other local, state or federal agencies to the extent necessary to process the pemut 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. 6. Your full name is required to process this application or permit. �'�j � V� lN�%' ' C First � . , iddle Last ` C �� , � Address �� /� /� � -�j ��_L �� , � r v Ciry State Zip Phone I und and my rights as stated a . Signature