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� Sec.13.04 RIGH'TS OF SLJB.TECTS OF D�TA Subd. 1. Type of data. The rights of individual on whom[he data is stored or to be stored shall be as set fonh in this secdon. Subd.2. Information reqirired to be given individual. .�n individual asked to supply private or confidendal dara concerning himself shall be informed of: (a)the purpose and in[ended use of the requested data within the collecting'statE agency,poliacal subdivision,or statewide system; (b)whecher he may refuse oY is legally required to supply che requesced data;(c)any lmown consequence arising from his supplying or refusing to supply private or confidendal data;and(d)the idendry of o[her persoas or enrides aurhorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesdeadve 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 propertv tax refund instructions instead of on those forms. Subd. 3. Access to data by iadividuai. Upon request to a responsible authority,an individual shall be informed whether he is the subject of scored data on individuals, and whether it is classified as public, privace 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 contenc and meaning of chat data. After an individual has been shown che priva[e data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuan[to chis secrion is pnnding or addidonal data on the individual has been collected 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 authoriry may require the requesring person to pay the actual costs of makine, certifying, and compiling the copies. The responsible authoriry shall comply immediately, if possible, wich 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 possibie. If he cannot comply with the request within rhat time,he shall so inform[he individual,and may have an additional five days within which to comply with the request,excluding Saturdays, Sundays and legai holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or pri�•ate data concerning himself. To exercise this right,an individual shall notify in wriang the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incompiece and attempt to nodfy past recipiencs of inaccurate or incomplete data, inciuding recipients named by the individual; or(b)noafy the individual that he believes the data to be correct. Data in dispuce shall be disclosed only if the individual's sta�emenc of disagreement is included with[he disclosed data. The decerminaaon of the responsible au[horiry may be appealed pursuant to the provisions of the administrarive procedure act reladng 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 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 pemut or license. 3. The information may be shared wich 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. j. You have certain ri�hts under M.S. 13.04 (available upon request) to review private data on yourself. 6, Your full name is required to process this application or permit. i � � ;� �JC_ � /�l � ° �°'= / �ddle Last First � � �� �-/ �� d� (�v�'``� �` , � Address � � /� �i� �� C� �/1�0N,!/"'� � �%/� ��.� � _�. Ciry � State Zip Phone I understand my ri?hts as stated above. � � Signature