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" . Sec.13.04 RIGHTS OF S[JB.TECTS OF D�TA Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be stored shall be as set fonh in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply privace or confidenrial dara concerning himself shall be informed of: (a)the purpose and intended use of the requesrcd data wi[hin the collecoing"state agency,pofidcal subdivisiou,or sratewide system; (b)whethet he may refuse or is legally required to supply[he requested data;(c)any laiown consequence arising fmm his supplying or refusing to supply privace or confidendal data;and(d)the idenriry of ocher persons or enrides authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invescieadve data, pursuan[to section 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav place the norice reauired under this subdivision in the individual income tax or propem tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible au[horiry,an individual shall be informed whether he is the subject of stored data on individuals, and whe�her it is classiFied as public, private or confidendal. Upon his further request, an individual who is the subject of stored private or public data on individuals shall be shown the data wichout any charge to him and, if he desires, shall be informed of the contenc and meaning of�hat data. After an individual has been shown che private data and informed of ics meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acdon pursuant to this secrion is pznding or addidonal data on the individual has been collected or created. The responsible authority 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 [he acmal costs of making,certifying,and compiling the copies. The responsible authoriry shall compiy immediately, if possible, with any request made punuant to this subdivision,or within five days of the date of the request,excluding Sacurdays,Sundays and legal holidays,if immedia[e compliance is noc possible. If he cannot comply with the request within that time,he shall so inforrtt the individual,and may have an addirional 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 ri¢ht,an individual shall noafy in wridng the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of inaccurate or incomplete data, inciuding recipients 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 inciuded with the disclosed data. The determination of the responsibte authoriry may be appealed pursuant to the provisions of the administradve procedure act reladng to 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 pernut 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 pemut or license requested. 2. You may refuse to supply data, but refusal may require tha[ the Ciry deny the pemut 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 pemut or license requires Council action to approve, some information may become pubiic. 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 this application or permit :�/ �- � �<:. � � First Vliddle �� Last ��r . � � �� c� ��,�. �-�,� Address � ,� f�� ;� ; �, �;�� - ��-�� C�� S�y�e Zlp Phone I understand my rights as stated above. f j— / � . Signature , �