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� Sec.13.04 RIGHTSOFSUBJECTSOFDATA Subdivision I. Type of data. The rights of individua!on whom the dala is stored or fo be stored shall be as set forth in this section. Subd.2. Injormation required to be given individuaL An indrvidual asked to supply private or confidential data concerning himselj shall be injormed of.• (a)the purpose and intended use ojthe requested data wrthin the collecting state agency,political subdrvisron,or statewide system;(b)whether he may refuse or is lega!!y requrred to supply the requested data;(c)any known consequence arising from his supplyrng or refusing to supplyprivate or confrdential data;and(dJ the idenlrry of other persons or entities authorized by state orfederal lmv to receive the data. This requirement shall not apply when an individual is asked to supply imestigative data,pursuant to section 13.81, subdrvision S, to a lmv enforcement officer. The commissioner of revenue mav place the notrce required under this subdivision in the rndividual income�ax or properry tax re(und instructions instead ofon those forms. Subd.3. Access ta data by 1ndlviduaL Upon request to a responsible authority,an individual shall be injormed whether he is the subject of stored data on individuals, and whelher it rs classifred as public,private or confidential. Upon his further request,an individual who is the subject of stored private or publrc data on individuals shall be shotivn the data ivithout any charge to him and,if he desrres,shall be informed of the content and meaning of that data. After an rndividual has been sho�vn the private data and informed of its meaning, the data need not be drsclosed to him jor six months thereafter unless a dispute or action pursuant 10 thrs section is pendrng or addrtional data on the indivrdual has been collected or created. The responsible authorrty shal!provide copres oJthe private or publrc data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual costs ojmaking,ceriifying,and compiling lhe copies. The responsible authority shall comply rmmediately,if possible,with any request made pursuant to this subdivisron,or withrn five days oJthe date of the request,excluding Saturdays,Sundays and legal holydays,f immediate compliance is not possrble. IJhe cannot comply with the request withrn that trme,he sha!!so rnform the individual,and may have an addrtional frve days tivithin ivhich to comply with the reguest,excluding Saturdays,Sundays and lega!holidays. Subd.4. Procedure when data is not accurate or complete An individual may contest lhe accuracy or completeness ofpublic or private data concerning himselj. To exercise thrs right, an individua!shall notify in writing lhe responsible authority describing the nature oj the disagreement. The responsible authorrty shall within 30 days either: (a)correct the datafound to be inaccurate or rncomplete and attempt to notify past recipients of inaccurate or rncomplete data,rncluding recipients named by the rndividual;or(b)notify the individua!that he believes the data to be correct. Data in drspute shall be disclased only if the indivrdual's statement of drsagreement rs rncluded with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisrons of the administrative procedure act relating to contested cases. DATA PRIVACYADVISORY In accordance with M S./3.04,Subd.2, "Rrghts ojsubjects of data",we would like to inform you that your request for a perm it or license from the City of Orono or any of its departments may require you to furnish certain prrvate or confrdentra!information. You are notifred that: l. The information you furnrsh will be used to determine your qualification for the permrt or license requested. 2. You may refuse to supply data, but refusal may requrre that the City deny the permit or license. 3. The information may be shared with other loca/,state or federal agenci�s to the extent necessary to process the permit or license. 4. Ij'your requested permit or license requires Counci!action to approve,some rnjormatron may become public. 5. You have certain rights under M.S.13.04(see follotivrng page)to revietiv private data on yourselj. 6. Your full name rs required to process this applrcation or permit. PLEASE PRINT First Middle Last n '� Address i j j r �.7 City State Zip Phone 1 un tand my ights as slated above. � Signature 10