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Sec.13.04 RIGIiTS OF SUB.TECTS OF D�TA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set for[h in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenrial data concerning himseif shall be informed of: (a)the purpose and intended use of the requesied data within the collecting"state ageacy, polidcal subdivisio�,or sratewide system; (b)whether he may refuse oY is legally required to supply the requested data:(c)any lrnown cocvsequence arising from his supplying or refusing to supply privace or confidenrial data;and(d)the iden�iry of ocher persons or endaes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesdgaave dara, pursuant to section 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of re�enue mav place the nodce reauired under this subdivision in the individual income tax or propertv tax refund instruc[ions ins�ead 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 stored data on individuals, and whe[her it is ciassified as public, private or confidential. Upon his further request,an individual who is the subject 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 chat data. After an individual has been shown che private data and informed of its meaning,the data need not be disclosed to him for six months thereafter uriless a dispute or acdon pursuant to this secdon is pending or addidonal data on the individual 6as been collected or created. The responsible authoriry 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 to pay the acmal costs of making, certifying,and compiling the copies. The responsible auchoriry shall comply immediately, if possible, with any request made pursuant to this subdivision, or within five days of the date of the request,excluding Sa�urdays,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 additional 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 concerning himself. To exercise this rieht,an individual shall noafy in wriang the responsible authoriry describing the nantre of the disagreement. The responsible authority shail within 30 days either: (a)correct the data found to be inaccurate or incompiete and attempt to noafy past recipients of inaccurate or incomplete data, including recipienLs named by the individual: or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with[he disclosed data. The determinaaon of the responsible authoriry may be appealed pursuant to the provisions of the adminisaadve procedure act relaang to contested cases. DAT� 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 will be used to determine your qualification for the permit or license requested. 2. You may refuse to supply data, but refusal may require that the Ciry deny the pemut or license. 3. The information may be sbared with other local, state or federal agencies to the extent necessary to process the pemut 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 � r� �� ; � ( First vliddle � Last c�<�5�` �.,�� -�. (��ti '� �`�- �C �--.� Address � _ �—, �� ^� 1.,�.i/�� 6� � ��"� !v �.'� \ � � Ciry State Zip Phone I understand y rights as stated above. i �' I �/ Signature