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� Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The riehrs of individual on whom[he data is scored or to be scored shall be as set fonh in this secaon. Subd.2. Information reqirired to be given individual. An individual asked to supply privace or confidenrial data conceming himself shall be informed of: (a)the purpose and intended use of the requested data wi[hin the collecang'state agency, policical subdivision,or statewide system; (b)whecher he may refuse oY is legally required ro supply[he requested data;(c)any known consequence arising from his supplying or refusing ro suppty private or co�dencial data;and(d)the idencity of other persons or entiaes au[horized by state or federal law to receive the data. This requiremen[shall not apply when an individual is asked to supply investieaave dara, pursuant to secaon 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav place the norice reouired under this subdivision in the individual income tax or oropem tax refund instnlctions instead ot on those forms. Subd. 3. Access to data by indi�idual. Upon reques[to a responsible au[horiry,an individual shall be informed whether he is the subject of stored data on individuals, and whether it is classified as public, private or confidential. Upon his further request, an individual who is the subjec[ of stored private or public data on individuals shall be shown the data without 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 iu meaning,the data need no[be disclosed to him for six months thereaTter unless a dispute or action pursuant to [his section is pending or addidonal data on the individual has been collected or created. The responsible au[horiry shall provide copies of the private or public data upon request by the individual subject of[he data. The responsible authoriry may require the requesting person ro pay the ac[ual costs of making, certifying, and compiling the copies. The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision,or within five days of the date of[he request,exetuding Saturdays,Sundays and:eeal holidays,if immediate compliance is no[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 wi[h the request,excluding Sarurdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or compfete. An individual may contest the accuracy or completeness of public or pri��ate data concerning himself. To exercise this rieht,an individual shall nocify in writing the responsible authority describing the nature of the disagreement. The responsible authoriry shall within 30 days ei[her: (a)correct the data found ro be inaccurate or incomplere and attempt to nodfy past recipien[s of inaccurate or incomplete data, including recipients named by the indiridual; or(b) notify the individual that he believes the data to be correct. Data in dispute sha►l be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the rzsponsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act reladng ro 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 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 deternune your qualification for the permit 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 wi[h 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. �, You have certain rights under M.S. 13.04 (availabie upon request) to review private data on yourself. (, Your full name is required to process this application or permit. c�I� � �t-ti� ��-t.,��..► First /�� tiddle Last � 7�oZ 5 1..�UM/�r ��c�.c:� r3� Addres� � S JG ,J � � ?'�� �L�Q • . �� J Ciry State Zip Phone I u er d my ri;hts as stated abov . � Signa re