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� � �. Sec.13.04 RIGH'TS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or[o be stored shall be as set forrh in this secdon. Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting"state agency,polidcal subdivision,or statewide system; (b)whether he may refuse oY is legaily required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidential data;and(d)the identiry of other persons or enaties authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesaearive data, pursuanc to secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav place the noace required under this subdivision in the individual income tax or propertV tax refund instructions instead 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 whether it is classified as public, private or confidenaal. 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. Afrer an individual has been shown che private data and informed of its meaning,che data need not be disclosed to hirn for six months thereafter unless a dispute or acaon pursuanc to this secdon is pending or addirional 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 the actual costs of making,certifying, and compiling the copies. The responsible authoriry shall comply immediately, if possible, with any reques[made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal 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 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 chis right,an individual shall notify in wricing the responsible authoriry describing the nature of the disagreement. The responsible auchoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of inaccurate or incomplete data, including 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 included with[he disclosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relating ro contested cases. DATA 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 pemut or license requested. 2, You may refuse to suppiy data, but refusal may require that the City 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 pernut 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 reque t) to review private data on yourself. (, You full name is required t process is application or permit. � l —s� v v� ��5` (`�LK--� Fi Middle / � Last �-�� ,7`� 5 i4�oa��--K�_ , Address � ��'A/ �r"`?/ � ��v� li✓� r/" .l 7��J Ciry Sta�e Zip Phone I understand my rights as sta[ed above. Signamre