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� , Sec.13.04 RIGH'TS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom[he data is stored or to be stored shall be as sec forth in this section. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenrial data concerning himself shall be infomted of: (a) the purpose and intended use of the requested data wi[hin the collecting'state agency, polidcal subdivision,or statewide system; (b)whether he may refuse or is leeally required to supply the requested data;(c)any Irnown consequence arising from his supplying or refusing to supply private or confidenaal data:and(d)the identiry of other persons or endries au[horized by state or fede�al law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data, pursuant to secrion 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of revenue mav place che norice required under rhis subdivision in the individual income tax or propertv tax refund inscrucrions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whe[her he is the subject of stored data on individuals, and whecher it is classified 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 wi[hout any charge to him and, if he desires, shall be informed of the content and meaning of that data. Afrer an individual has been shown the private data and informed of its meaning, the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this secdon is pending or additional data on the individual has been collected or creaced. The responsible authoriry shall provide copies of the private or pubtic data upon requesc by the individual subject of the data. The responsible au[horiry may require the requesting person to pay the actual costs of making, cerafying, and compiling the copies. The responsible authoriry shall comply immediately, if possible, with any request 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 not possible. If he cannot comply with the reques[ within that time,he shall so infornt the individual,and may have an addido�al five days within which to comply wi[h the request,excluding Saturdays, Sundays and lega(hotidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himseff. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either. (a)correc[the data found to be inaccurate or incomplete and attempt to norify past recipieats of inaccurate or incomplete data, including tecipiencs named by [he individual; or(b) notify the individual that he belizves the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determinaaon of the responsible authoriry may be appealed pursuant to the provisions of the administradve procedure act relating 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 permit or license from the City of Orono or any of its departments may require you to fumish cercain private or confidential information. You are notified that: 1. "I'he 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 that the City deny the pernut or license. 3. 'I'he 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 request) to review private data on yourself. 6. Your full name is required to process this application or permit. �1 JT'�v..�� S LJ - � ��z,�� - First �Siddle Last Z774I ��,i v;, y• r� �t�.�. . /l.� f� Address 'S�. ., � 1"?L ��==� ��s �;��:�� C�n, State Zip Phone I u erstand my righ� as sta a ove. .: I „ � ` {,. �.. �V' Signature