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r � . � Sea13.04 RIGHTS OF SUB,TECTS OF DATA ' Satd. 1. Type oC data. The righcs of individual on whom�he dam is sto�cd or to be scnced shall be as sec forch in this secaon. Subd.2. Iatormation reqiured to be given individual. �1n individual uked to supply private or confidenrial dara conccraiag himself shall be informed of: (a)the purpose and intendcd use of the requested data wichin the eoIIecang Etatt ageacy,polidcal subdivision,or statewide rysum; (b)wheef:er he may r:fuse or is_legaily requir_d to suppty che r.quesud data;(c)aay laiawn coasequence arising from tiis supplyiag or refusing to supp[y privace or con:.der.aa.l data;and(d)the idendry of ocherpersoas orenodes au[horized by staee or federal law ro teceive t�e daca. 'Ihis requitemenc shali not apply when an ir:dividual is asked to supply iavesrigacve daa,pursuanc ro secaon 13.82,subdivuion 5,to a law enforcemeat o�cer. '[ha eeclmissioner of revenue mav oface �he nodc- rauird und-r chis subdivision in che individual income nz or orooem az refund ins�ructions insuad of on chose forms. Subd. 3. ?.ecess to data by individual. Upon requesc to a responsible aurhority,an individual shall be informed whether he is che subject of stor:d daa on individuals,and whecher it is ctassified as public,Qrivace ar conF.dendal. Upon his furcher request,an individual who is th:subjecc of scor_d privace or public data on individuats shall be shovm che dan wichouc any charge to him and;if he desues, shall be informed of che concanc and meaning of[hat dara. Afrer an individual has been shown the privac.dan and informed of ics meaning,[he dam need not be d'uclosed ro him for siz monchs thereafter uriless a dispute or acdon pursuant to this secdon is pending oc addidonal data on the individual has beea eollecc�d or creaced. The responsible aud:oriry shall provide copies of�he privac:or public data upon request by che individual subject of the daca. Tha responsible auchoriry may require the requ:sang pe�son to pay[he acntal coscs oi making, cerrifying,and compiling the capies. The responsible au[ttoriry shail comply immediately, if possible,wieh aay tequest made pursuant to this subdivision,oc wichin five days of the date of�he reques[,ezcluding 5aturdays,Sundays and legal holidays,if immediate compliance is not possible. If he canaot comply with the request within[hat dme,he shal!so inform che individual,and may have an addidoaal five days wi�hin which to comply with the request,excluding Sacurdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accurdcy or completeness of public or private dara conceming himself. To ezercise this right,an individual shall noufy in wriang[he responsible auchoriry dascribing the nature of the disagreemenc. The responsible authoriry shall within 30 days eitt;er: (a)correcc c'�e data found to be inaccurac�or incomplete and aaempc to nodfy past recipien�s of inaccurdte or incomplete data, inciuding recipien¢named by the individual; or(b)nodfy the individual thac he believes the dara to be correcG Data in dispuce shall be disclosed only if the individual's sta[emenc of disagreem:nt is includcd with the disclosed data. 'I�e decerminaaon of[he responsible auchoriry may be appealed pursuanc to the provisions of the admirustrarive proc:dure act relaang to contesud cases. � DATA PRIVACY ADVISORY In accordance wich M.S. 13.04, Subd.2, "Ri�hcs of subjeccs 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 de�ermine your qualification for the permi[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 wich ocher local, sta�e or federal agencies to the ettent necessary to process the permit or license. 4. If your requested permit or license requires Council action to approve, some information may become public. �. 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 applicatioa or permit. —� 1� i _j �, �- �'/�� ,ll l-C Firsc titiddle c L/ /�:1- � _��:�. �, . (.' .'�� /" I / Address � '--+�,� -, '-:' � r">%!� � � ��.—' `� Ciry Sace Zip Ptione I understand my ri�hts �s stated above. � � � j �� ` /!. /�� ;A'. $Ig[L1 G �i� • �.