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'� Sec.13.04 RIGH'I'S OF SUB.TECTS OF D�1TA Subd. 1. Type of data. The righ[s of individual on whom[he data is stored or to be stored shall be as set fonh in this secdon. , Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himself shall be informed of: (a)the purpose and iatended use of the requested data within the colleccing"state agency, political subdivision,or statewide system; (b)whether he may refuse ot is legally required to suppty the reques[ed data;(c)any Irnown consequence arising from his supplying or refusing to supply private or confidenaal data;and(d)the identiry of other persons or enriaes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesrieadve data, pursuan[to secdon 13.82, subdivision 5, ro a law enforcement officer. The commissioner of re��enue mav piace the noace reauired under this subdivision in the individual income tax or propectv tax refund instructions inscead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible au[horiry,an individual shail be informed whether he is the subject of stored data on individuals, and whe[her it is classified as public, private or confidendal. Upon his further request,an individual who is the subject of scored private or public data on individuals shall be shown the data wichout any charge to hun and, if he desires, shall be informed of the content and meaning of chat data. Afrer an indi�+idual 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 acrion pursuanc to this secrion is oending or addidonal data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or pubiic data upon request by the individual subjec[of che dara. The responsible authoriry may require the requesting person to pay the accual costs of making, certifying, and compiling the copies. The responsible auchoriry shall compty immediacely, if possible, wich 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 addirional five days within which to comply wich the request,excluding 3aturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may conrest the accuracy or completeness of public or pricare data concerning himself. To exercise chis rieht,an individual shall noafy in writing the responsible authoriry describing�he nature of the disagreement. The responsible authoriry shall within 30 days either. (a)correct the data found ro be inaccurate or incomplete and attempt to nodfy past recipienu of inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individual that he believes the data to be correct. Data ut dispuce shall be disclosed only if the individual's statement of disagreement is inctuded with the disclosed data. T}ie de[erminarion of the responsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act reladng 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 reauest 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 information may become public. 5. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. (. Your full name is required to process this application or permit. � I I I n �y � l L ��I�� First Middl Last 3`fi�(� 5��,� /�-e Add�eS �i�.�7--C---- ��(I v S��`7� � � L� Ciry I State Zip Phone I underst my rights as stated above. .:. Signature