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� . � Sec.13.04 RIGfITS OF SUB.TECTS OF DATA Subd. 1. Type of data. The righu of individual on whom the dara is stored or to be stoied shall be as set forth in this secdo�. Subd.2. Information required to be�ven individual. An individual asked to supply private or confidential data conceming himself shall be informed of: (a) the purpose and intended use of the requesced data within the collecdng'state agency, political subdivision,or statewide system; (b)whether he may refuse or is legally required to supply the requested dan;(c)any known coasequence arising fmm his supplying or refusing ro supp(y private or confidenrial data;and(d)the idendry of other persons or enddes au�horized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesdgadve data, pursuant to secdon 13.82, subdivision 5, [o a law enforcement officer. The commissioner of revenue mav place che nocice required under this subdivision in the individual income tax or prooem tax refund instructions instead of on those forms. Subd.3. �ccess to data by individual. Upon request to a re�onsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals, and whether it is classified as public, private or co�dendal. Upon his further request, an individual who is che subject of stored private or public data on individuals shall be shown the data wi[hout any charee to him and, if he desires, shall be informed of the content and meaning of that data. After an individual has been shown[he private data and informed of ia meaning, che data need not be disclosed to him for six months thereafter unless a dispute or acrion pursuant to this secdon is pending or addidonal data on the individual bas been collected or crza�ed. The responsible authoriry shall provide copies of the private or public data upon requesc by the individual subject of the data. The responsible authoriry may require the requesting person to pay the acrual coses of making, cerdfying, and compiling the copies. The responsible authority shall comply immedia[ely, if possible, with any request made pursuanc to this subdivision,or wi[hin 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 requesc within that[ime,he sha(1 so inform the individual,and may have an additional five days within which to comply wi[h the request,excludin;Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or compiete. An individual may contest che accuracy or completeness of public or private data conceming himself. To exercise rhis nght,an individual shall nodfy in writing the responsib(e auchority describing the�ature of the disagreemenc. The responsible authority shall within 30 days either. (a)correct the data found to be inaccurate or incomQlete and attempt to notify past recipienu of inaccurate or incomplete data, including recipienu named by che individual; or(b) notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if[he individual's statement of disagreement is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the administradve proceduce act relating [o contesced cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "Riehts of subjects of data", we would like to inform you that your request for a permi[ 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 City deny the permit or license. 3. The information may be shared with other local, state or federal aQencies [o 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 M.S. 13.04 (available upon request) to review private data on yourself. 6. Your full name is required to process chis application or permit. 1��.0�57� �/�� '��-�Son/ J .r . First �7z�, Middl� Last �� 5 f ��`��'-�- Address , �� L/ ?, � C� z — � � /�0�,��r ✓ .J Ciry —7 Sta�e Zip Phone I understand my rights as stated above. � � �` Signature