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. _ • • . Sec.13.04 RIGH'TS OF SUBJECTS OF D�T� Subd. 1. Type oF data. The righrs of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Informarion reqirired to be given individual. An individual asked to suppiy privare or confideadal data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecring'state agency, polidcal subdivision,or sratewide rystem; (b)whecher he may refuse oT is legally required to supply the requested data;(c)any lrnown consequence arising from his supplying or refusing to supply priva[e or confidential data;and(d)the idendry of other persons or endaes authorized by state or federal law to receive the data. This requirement s6a11 not apply when an individual is asked to supply invesdeaave dara, pursuant to secaon 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of re��enue mav place the norice reouired under this subdivision in the individual income tax or oropertv tax refund inscructions insczad of on[hose forms. Subd. 3. Access to data by individual. Upon requesc to a responsible authority,an individual shall be informed whether he is the subjecc of stored data on individuals,and whecher it is classified as public, private or confidenoal. Upon his further request, an individual who is the subjecc of stored private or public data on individuals shall be shown[he dara wi�hout any charge to him and,-if he desires, shall be informed of the contenc and meaning of�hat data. Aftzr an individual has been shown che privace data and informed of its meaning,the data need not be disclosed to him for six monchs thereafter unless a dispute or acrion pursuanc to this secdon is pending or addidonal data on the individual 6as been collected or creaced. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the actual costs of making, cemfying, and compiling the copies. The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision,or wi[hin five days of the date of the request,excluding Saturdays,Sundays and lega]holidays,if immediate compliance is not possibie. If he cannot comply with the requesc wichin[hat time,he shall so inform the individual,and may have an addiaonal five days within which to comply wi[h the request,exc!eding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. M individual may contesi the accuracy or completeness of public or private data conceming himself. To exercise this right,an individual shall noofy in wridng the responsible authoriry describing[he nacure of the disagreement. The responsible auchoriry shall within 30 days ei[her: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of inaccurate or incomplete data, inciuding recipiena named by che individual;,or(b)nodfy the individual that he believes the data to be correcc. Data in dispuce shali be disc(osed only if the individual's stacemenc of disa;reement is included with the disclosed data. The decerminarion of che respensible authoriry may be appealed pursuant to the provisions of the administrarive procedure act relacing 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 pemu[ 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 permit or license requested. 2. You may refuse [o 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 permit 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 h1.S. 13.04 (available upon request) to review private data on yourself. 6. Your full name is required to process this application or permit. ; Z� � ��h� � �;'� �'�. FirSt �, �--_ �tiddle Last �� /��' �Z��;,� �, Address - ��a- i"'' Y� S �-� � � <�;�,/� .�_S`_,��;�T C�ry, State Z�p Phone I understand my rights as stated above. , _ � ' � i �,�. � gnatu�e�' =" r /� �