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� . � Sec.13.04 RIGHTS OF SUBJECTS OF DaT� Subd. 1. Type of data. The righ�s of individual on whom the data is stored or co be scored shall be as set forth in this secrion. Subd.?. Information required to be given iadividual. An individual asked ro supply priva[e or confidendal data concerning himself shall be informed of: (a)the purpose and intended use of the reques[ed data within the colleccing"state agency, polidcal subdivision,or statewide system; (b)whether he may refuse oY is legally required ro suppl,v the requested data;(c)any known consequence arising from his supptying or refusing to supply private or confidential data;and(d)the identiry of other pzrsons or enndes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesaeaave dare, pursuant to secdon 13.82, subdivision�, to a law enforcement officer. The commissioner of re�enue mav place the norice reauired under this subdivision in the individual income tax or propertv tax refund instructions instead of on those forms. Subd. 3. Access to data by indicidual. Upon request to a responsible au[hority,an individual shall be informed whether he is the subject of stored data on individuals, and whecher it is classified as public, private or confidential. Upon his fur[her request, an individual who is the subject of stored private or public data on individuals shall be shown the data without any charge to him and, if he desires, shall be informed of the content and meaning of that data. Afrer an individual has been shown�he private data and informed of its meaning. che data need not be disclosed to him for six months thereaTter unless a dispute or action pursuan[to this secaon 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 requesc by the individual subjecc of the data. The responsible authoriry may require the requesting person to pay the acmal coscs of making, certifying,and compiling the copies. The responsible authoriry shali comply immediately, if possible, with any request made pursuant to this subdivision, or within five days of the date of rhe 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 rhe individual,and may have an addicional 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 this righ[,an individual shall nodfy in writing the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccueate or incomplete and attempt[o norify past recipients of inaccurate or incomplete data, inctuding 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 de[ermination of the responsible authoriry may be appealed pursuant to the provisions of[he administraave procedure act reladng to contesred cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "Ri�hts 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 pernut 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 pernut 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 �o process this application or permit. i� / �C�FY ��_ '�)��-�'/' y-z'� � S` .�u�� , First `�1�dd1� Last '7� � � � 1 Address � � l �� .J��G�� ,�j / ' C--`�/ :� ., ;� � Ciry State Zip Phone I unders c� my rights as stated above. ___ �� ! - � Signacure