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♦ �I Sec.13.04 RIGHTS OF SUB.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 forth in this secdon. 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 requested data within the collecang"state agency,polidcal subdivision,or sratewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any lmown consequence arising fmm his supplying or refusing to supply privace or confidenrial data;and(d)the idenriry of o[her pecsons or enriaes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesrigadve dara, 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 instructions instead of on those forms. Subd. 3. Access to data b�individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whe[her it is classified as public, privace or confidendal. Upon his further request, an individual who is the subject of stoted private or public data on individuals shall be shown the data wi[hout any charge to him and,'if he desires, shall be informed of the content and meaning of that data. After an individual has been shown the private data and informed of its meaning,che data need not be disclosed to him for six months thereafter unless a dispute or acrion pursuant[o this seccion is pending or additional 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 che data. The responsible authority may require the requesdng person to pay the actual costs of makine, cercifying,and compiling the copies. The responsible authority shall comply immediately, if possible, with 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 possible. If he cannot comply with the request wi[hin[hat time,he shall so inform the individual,and may have an additional five days within wtuch to comply with[he request,excluding Saturdays, 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 private data conceming himself. To exercise this right,an individual shali notify in wriang the responsible authority describing[he narure of the disagreement. The responsiblz authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of inaccurate or incomplete data, including recipiencs named by the individual; or(b)notify the individual that he believes the data to be cocrect. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determinarion of the responsible authoriry may be appealed pursuant to the provisions of the adminisuarive procedure act relating to contesred 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 Ciry 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 pemut or license. 3. The information may be shared with other local, state or federal agencies to the extent necessary to process the permit or license. 4. If your requested permit or license requires Council action to approve, some information may become public. j. 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. Se 1 �12o a�'�� First �' ) dd/le Last `I'GO l�1CC'�'l 5'�O� �lUi.� Address � .�-� Z a v,5 �� r I� Vv� n �S'�/�� I��.�.3 -��'`�� _ Ciry State Zip Phone I underst d rights as t d above. . �--._ �� Signature v