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( ? � . . Sec.13.04 RIGHTSOFSUBJECTSOFDATA Subdivision 1. Type ojdala The rights of indrvrdual on whom the data is stored or to be stored shall be as set forth rn thrs section. Subd.2. Injormation required to be given individuaL-An ind�rdua!asked to supply prrvate or confidentral data concerning hrmselj shall be informed of.' (a)Ihe purpose and intended use of the requested da7a within the collecting state agency,politica!subdivision,or state�vide system;(b)whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplyrng or refusing to supply private or confidential data;and(dJ the identiry of other persons or entities aulhori�ed by state or jederal!mv to receive the data. Thrs�equirement shal!not apply when an indrvidua!rs asked to supply investigative data,pursuant to section 13.82, subdivision S, to a Imv enforcement offrcer. The commrssioner of revenue may place the notice required under this subdivisron in the individt�al income tax or properry tax refund instrttclions instead ofon those forms. Subd.3. Access to data by individuaL Upon request to a responsible aulhorrry,an rndividual shall be informed whether he rs the subject ojstored data on individuals, and whether it is classrfred as public,prrvate or confidential. Upon his jurther request,an individua!who is the subject of stored private or public dala on indrvidt�als shall be shoivn the data tivrlhout any charge to him and, if he desires,shal!be informed oJ the content and meaning of that data. After an rndividual has been shoivn 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 pursuant to this section is pending or additional data on the individua!has been collected or created. The responsible authoriry shall provrde copies ojthe private or public data upon request by the rndrvidua!subject of the data. The responsible authority may require the requesting person to pay the actual costs of making,cert�rng,and compiling the copies. _ The responsible a:�thority shall comply immediately,rfpossible,ivith any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if rmmediate complrance is not possible. If he cannot comply with the request within that time,he shall so injorm the individual,and may have an additronalfive days tivithrn which to comply with the request,excluding Salurdays,Sundays and lega(holidays. Subd.4. Procedure when data is not accurate or complete. An indrvidual may contest the accuracy or completeness ofpublrc or prrvate data concerning himself. To exercise this right, an individual shall nol�in wrrting the responsrble authoriry describing the nalure of the disagreement. The responsible authority shall withrn 30 days either: (a)correct the data found to be rnaccurate or incomplete and attempt to nolify past recipients of inaccurate or incomplete data,including reciprents named by the individual;or(b)not�the rndividua[that he believes the data to be correct. Data rn dispute shall be drsclosed only if the indrvidua!'s statement ojdrsagreement rs included tivith the disclosed data. The determination of the responsible authority may be appealed pursuant to Ihe provisions of[he administrative procedure act relatrng to contested cases. DATA PRIVACYADVISORY In accordance with M S.13.04,Subd.2, "Rrghts ofs:ibjects ojdata';ive tivould like to rnform you that your requestfora permit orlrcense from the City of Orono or any ojits departments may require you to furnish certain private or confidential information. You are notified that: l. The informatron you furnish wrll be used to determine your qualifrcation for the permit or license requested. 2. You may rej�use to supply data,but refusal may require that the City deny!he permit or license. 3. The injormation may be shored wr[h other local,state or1'edera!agencres to the extent necessary to process the permit or lrcense. 4. /f your requested permit or license requires Counci!actron to approve,some injormation may become public. 5. You have certarn rights under M.S. 13.04(see jolloiadng page)to revietiv prrvate data on yourselj. 6. Your jull name is required to process this application or permit. PLEASE PRINT ��r�l� (�(.�7s'��!^�l First Middle Last �35a or�� n�%�w�� -� Address v�to�r,u;..� iH �.� s�3f� � �r'� - o�S�- �So <� Crry State Zip Phone I understan y r e a ove.i Signature � /0