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Sec.13.04 RIGH"I'S OF SLJBJECTS OF DaT�1 Subd. 1. Type of data. The riehcs of individual on whom the data is stored or co be stored shall be as set forth in this secrion. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenrial data concerning himself shall be informed of: (a)the purpose and intended use of the requesced data within[he coliecting"state agency, polirical subdivision,or sratewide system; (b)whe[her he may refuse oY is legally required to supply the requesced data;(c)any laiown consequence arising from his supplying or refusing to supply priva[e or confidentiai data;and(d)the idenriry of other persons or enddes authorized by state or federal law to receive the data. This requiremeot shall not apply when an individual is asked to supply invesdeadve dara, pursuant to secdon 13.82, subdivision 5, ro a law enforcement officer. The commissioner of re�enue mav place the nodce reauired under this subdivision in the individual income tax or properN tax refund instructions instzad of on those forms. Subd. 3. Access to data by indi�ldual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public, private or confidenaal. Upon his further request, an individual who is the subjec[ of stored private or public data on individuals shall be shown che data wichout any charge to him and, if he desires, shall be informed of the content and meaning of�hat data. After an individual has been shown the private data and informed of iu meaning, the data need not be disclosed to him for six months thereafter unless a dispute or acdon pursuan[to this section is pending or additional data on the individual has been collected oc crea[ed. The responsible auchoriry shali provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require che requesting person to pay the actual costs of making, certifying, and compiling the copies. The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision, or within five days of the date of the request,excfuding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request wi[hin that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,exeiuding Sa[urdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or comple[eness of public or private data concenting himself. To exercise this rieht,an individual shall nodfy in wridng the responsible authoriry describing rhe nature of the disagreement. The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccunte or incomplete and attempt to nodfy past recipienu of inaccu�ate or incomplete data, including recipients named by [he individual; or(b)notify the individual tha[he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statemenc of disagreement is included wi[h the disclosed data. The de[erminarion of the responsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act relarine 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 Ciry deny the pemut 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. �, You have certain rights 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. �� C"1 � l��R�. �1'r L��("��L First � ;�fiddle Last .�.a�.a�, � �l�\,Ls=.�� r' `V� � Address � ��, ' ts1` /�.T�('; � ( �� e i�'� � � "� l� —LJ 1�1 Ciry State Zip Phone I understand my ri�hts as stated above. � v ' Signature