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Sec.13.04 RIGHTS OF SUBJECTS OF D�TA 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. Informatiou required to be given indiridual. An individual asked to suppty private or confidendal data concerning hunself shall be informed of: (a)the purpose and intended use of the requested data within the collecdng§tate agency,polidcal subdivision,or statewide system; (b)whether he may refuse or is legally required to supply Ihe requested data;(c)any known consequence arising from his supplying or refusing to supply private or confideodal data;and(d)the idenciry of other persons or enodes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigadve data,pursuant to secuon 13.82, subdivision 5, to a law enforceme¢t officer. The commissioner of revenue mav place the noace required under this subdivision in the individual income tax or property tax refund instrucrions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual sha((be informed whether he is the subject of stored data on individuals,and whether it is classified as public, private or confidentiaL Upon his further request,an individual who is the subject of stored private or public data on individuais shail be shown the data without any charge to him and, if he desires, shall be informed of the content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action purs�.u�t to this section is pending or additional data on the individual has been collec[ed or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible auchoriry may require the requesan�person to pay the actual costs of making, certifying, and compiling the copies. The responsible authority shall 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 legat 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 himszlf. To exercise this rieht,an individual shall notify in writing the responsiblz authoriry dzscribing the natuce of the disagrezment. The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients 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 disaereement is included with the disclosed data. The derermination of U�e �esponsibfe authoriry may be appealed pursuant to the provisions of the administrative procedure act relacing to contestzd cases. DATA PRNACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data", we would Iike.ID 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 deternune your qualification for the permit or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the pernut 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. • �. You have certain rights under M.S. 13.04 (available upon reques[) to review private data on yourself. 6. Your full name is required to process this application or permit. �/�i� �� H/LL>Ew�.�v.�/ First Middle Last ��D Z W ooAdR't-� L�e• Address l�t�oot�8�,a� M,�/, SS�2� �3/-3iS,3 . , Ciry State Zip . Phone I understand my rights as stated above. �� X/ Signature