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- , � Sec.13.04 RIGH'TS OF SUBJECTS OF DATA 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�ven individual. An individual asked to supply private or co�denrial data concerning himself shall be informed of: (a)the purpose and intended use of the requesced data within 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 known consequence arising from his supplying or refusing to supply private or confidential data;and(d)the identiry of other persons or enrides au[horized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investieadve dara, pursuanc to secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav place the nodce required under this subdivision in the individual income tax or propertv tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of scored data on individuals,and whecher it is classified as public, priva[e or confidenaal. Upon his further request, an individual who is the subjecc of stored 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[hat data. Afrer an individual has been shown the privace data and informed of its meaning,the data need not be disciosed to him for six mon[hs thereafter unless a dispute or acrion pursuan[to this secdon is pending or addidonal data on the individual has been collected or created. The responsibie authority shall provide copies of the privace or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual costs of making, cerrifying, and compiling the copies. The responsible au[horiry 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 within that time,he shall so inform the individual,and may have an addiaonal five days within which to comply with the 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 pri�•ate data conceming himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of[he disagreement. The responsib(e authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify 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 correct. Data in dispute shall be disctosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant ro the provisions of the administrative procedure act reladng 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 wiil 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 pernut or license. 4. If your requested pernut 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 �l/V�� / `y' l ` � �liddle Last F'r t ��r� t�-"�� v�� c�� �A res r ��"V ✓ ''��c/-� `,J ,� ,?' ,�i,J'`� � v��i d�Sd'� 1� - Ciry Stare Zip Phone I understand my rights as s�tat� above. : � �_ Signa[ure