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� Sec.13.04 RIGHTS OF SUBJECTS OF DAT.� Subd. 1. Type of data. The righ�s of individual on whom[he data is stored or co be scored shall be as set forth ia this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenrial data conceming himself shail be informed of: (a) the purpose and incended use of the requesred dara within the collecang'state agency, polidcal subdivision,or sratewide system; (b)whe[her he may refuse or is Iegally required to supply tbe requested data;(c)any lrnown consequence arising fmm his supplying or refusing to supply � privace or confidendal dara;and(d)[he idenriry of other persons or enddes au[horized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesrieadve dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement ofFicer. - The commissioner of re��enue mav place the nodce reauired under this subdivision in the individual income tax or propem tax refund instrucaons inscead of on�hose forms. Subd. 3. Access to data by individual. Upon request to a responsible au[horiry,an individual shall be informed whether he is the subject of stored data on individuals,and whe�her ic is classified as public, privace or confidenrial. Upon his further request, an individual who is the subjecc of stored private or public data on individuals shall be stiown che data wichout any charge to him and, if he desires, shall be informed of the content and meaning of[hat data. Afrer an individual has been shown[he privace data and informed of ics meaning,the data need no[be disclosed to him for six monchs thereafter unless a dispute or acrion pursuanc to this secdon is pending or addidonal data on[he individual has been collected or creaced. The responsible authoriry shall provide copies of the private or public data upon request by[he individual subject of the data. The responsible authoriry may require che requesting person to pay the actual coscs of making, cerrifying, and compiling the copies. The responsible auchoriry shall comply immediacely, if possible, wich any request made pursuan[to this subdivision,or within five days of the date of che request,excluding Sa�urdays,Sundays and lega]holidays,if immediate compliance is not possible. If he cannot comply with the requesc within[hat time,he shall so inform che individual,and may have an addirional five days within which to comply wi�h the request,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 pri�•ate data concerning himself. To exercise chis right,an individual shall noafy in wriang the responsible authoriry describing[he nacure of the disagreemenc. The responsible authoriry shall wichin 30 days eicher: (a)correce the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of inaccunte or incomplece dara, induding recipienrs named by [he individual; or(b)noafy [he individual that he believes the data to be correcc. Data in dispute shall be disclosed only if the individual's statement of disa;reemenc is included with the disclosed data. The determinarion of the responsible au�horiry may be appealed pursuanc to the provisions of the adminisrrarive procedure act relaang to contested 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 permit or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the perm.it 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 ri�hts under M.S. 13.04 (available upon request) to review priva[e data on yourself. 6. Your full name is required to process this application or perm.it. , . � -� � c_��- � ; �j'c �?„~ � l L ��" '> ��°i i' /� c_f�_ L �_ / irst �fi�¢e j Last � <—� �� C's� Address „ ��7 �/ v �� c" ' ' ' .�� .—C��5/ ``'�f /C !7 Ci ��/L�.� �% I � ��-�'�, - _ : ,�-�� / - �i�y State Zip Phone I understand my �hts as stated above. � -/ , ��•� _ �—'�'� �_ Signacure �