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� r' Sec.13.04 RIGHTS OF SUBJECTS OF DaTA Subd. I. Type of data. "Ihe riehrs of individual on whom[he da[a is stored or to bz scored shall be as set fonh in this secdon. Subd.2. Information reqirired to be given individual. �.n individual asked to supply private or confidenrial dara cooceming himself shall be informed of: (a) the purpose and inrended use of the requesred data within[he collecang"sta[e agency, polirical subdivision,or stacewide system; (b)whe�her he may refuse or is legally required to supply the requested data;(c)any laiown consequence arising from his supplying or refusing to supp(y � private or confidenrial data;and(d)the idenary of ocher persons or enaaes aachorized by state or federal law to receive the data. Tais requiremeat shall - no[apply when an individual is asked to supply invesdeadve dara, pursuan�co secaon 13.82, subdivision 5, [o a(aw enforcemenc ofrccer. The commissioner of re�•enue mav (ace the noace reauired under this subdivision in the individual ir.come tax or orooem tax refund instrucdons ins�ead of on rhose forms. Subd. 3. Access to data by individual. Upon reques�to a responsible authoriry,an individual shall be informed whether he is the subject of scored data on individuals,and whe�her it is classified as public, priva�e or confidenoal. Upon his further requesc,an individual who is the subjecc of stored private or public dara on individuals shali be shown the dac3 wichout any charge to him and,-if he desires, shall be informed of che content and meaning of chat data. Afrer an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six monchs chereattec unless a dispuce or acdon pursuanc co rhis secdon is pznding or addidonal data on che u:dividual has been collected or creaced. The responsible authoriry shall provide copies of�he private or public data upon requesc by che individual subjecc of rhe data. The responsible authoriry may require the requesring person to pay the ac�ual coscs of makine,certifying,and compiling the copies. The responsible authoriry shall comply immediately, if possibte, wich any requesc made pursuant to this subdivision, or wichin five days of the date of the request,exciuding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot compty with the requesc wi[hin tha[dme,he shall so inform[he individual,and may have an addirional Five days within which co comply wi[h the requesc,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuncy or completeness of public or private data concerning himsetf. To exercise this righc,an individual shall noa"ry in wrian�the responsible authority dzscribing the nantre of the disagreement. The responsible auchoriry shall wi�hin 30 days ei[her: (a)correct the data found to be inaccurace or incomplete and attempc to noafy past recipients of inaccurate or incomptete data, including recipients named by the individual; or(b)notify the individual that he believes[he data ro be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is includzd with the disclosed data. The decerminarion of the responsible au�horiry may be appzaled pursuant to the provisions of the admuilscradve procedure act relatin, to conrested 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 Ciry 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 permit 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 o�her local, state or federal agencies to the extent necessary to process the permit or license. 4. If your requested permit or license requires Council action to approve, some information may become public. 5. You have cenain riohts under M.S. 13.04 (available upon request) to review private data on yourself. 6. Your full name is required [o process this application or permit. � �yC?T��`vE`C— �L j�!t_- / l,'I .j�� - First �tiddle Last �3� ��=�- S`�� Z�'S' Addres� �L ��'� ��x�-�-��.s-..- �''�G� SS33 / ��z - 3�z-�=3 �`��<<�T. Ciry Smte Zip Phone I understand my ri� as stated above. �,., , Signature