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. y Sec.13.04 RIGH'TS OF SUB.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 set forth in this secdon. Subd.2. Information required to be given individual. An individual asked to supply private or confidential dara concerning himself shall be informed of: (a)the purpose and intended use of the requested dara within the collecting'state agency,polidcal subdivisioo,or statewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any lmown consequence arising fmm his supplying or refusing to supply private or confidenrial data;and(d)the identiry of other persons or endties authorized by state or fede�al law to receive the data. This requirement shall not apply when an individual is asked to supply invesogadve dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement officec. The commissioner of re�enue mav place the norice reouired under this subdivision in the individual income tax or propectv tax refund instructions insrezd of on those forms. Subd. 3. Access to data by indi��dual. 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 confidenaal. 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 him and, if he desires, shall be informed of the content and meaning of that data. Aftzr an individual has been shown the private data and infoaned of iu meaning,che data need not be disclosed to him for six months thereafter unless a dispute or acrion pursuanc to [his secdon is pending or addidonal data on the individual has been collected or created. T'he responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the acrual cosu of making, cerafying, and compiling the copies. The responsib(e authoriry shail comply immediately, 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 not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an additional 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 right,an individual shall notify in writing the responsible authority describing�he nature of the disagreement. The responsibie authoriry shall wi[hin 30 days either. (a)correct the data found to be inaccunte or incomplete and attempt to nodfy past recipienu of inaccurate 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 statement of disagreement is included with the disclosed data. The determination of the responsible 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 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 deternune your qualification for the pemut or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the permit 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. (. Your full name is required to process this application or permit. �� i C�S� �.Z� I ) First Middle Last � � Address . ��l _��n�7v� �O Irl Ol L-l�� '�(�11'1 P`�0�� J�J 3�(n d `'t J C�ty State Zip Phone I understand my rights as stated above. � �t�l/ Signature