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� � � Sec.13.04 RIGH'I'S OF SUBJECTS OF D:�TA Subd. 1. Type of data. The rieh[s of individual on whom[he data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information required to be given individual. An individual asked to suppiy privace or confiden[ial data concerning himself shall be informed of: (a)the purpose and intended use of the requesced data wichin the collecting'state agency,polidcal subdivision,or statewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any 1�own consequence arising fmm his supplying or refusing to supply private or co�denrial data;and(d)the identiry of other persons or enriaes au[horized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigaave data, pursuant to secaon 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 insteuctions instead of on those forms. Subd. 3. Access to data by indicidual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether ic is classified as public, priva[e or confidential. Upon his further request,an individual who is the subjecc of stored priva[e or public data on individuals shall be shown the data without any charge to hun and, if he desires, shall be informed of the content and mea^ing 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 acaon pursuant to this section is pending or addiUonal data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay[he actual costs of making, cerrifying, 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 da[e 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 addicional five days within which to comply wi[h the request,excluding Sarurdays, Sundays and legal 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 conceming himself. To exercise this rieht,an individual shalt norify in wriang the responsible authoriry describing the narure of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to norify past recipienu of inaccurate or incomplete data, induding recipients named by the 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 statement of disagreement is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant[o the provisions of the administradve procedure ac[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 pemut or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the permit 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 informa[ion may become public. g, 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. ^ �' �.4,� ,� fQ� ��fa� First �vfiddle Last 2 Z�'� : 1 1; _ �/��/ Address �'� ��(7 y G, ri > j�� ( �J � � C�� State Zip Phone ty I understand my rights as stated above. �/ C � _ Signacure