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� Sec.13.04 RIGHTS OF SlII3JECTS OF DATA 1 Subd.1. Type of data. Thc rights of individual on whom the data is stored or to be stored shall bc as set furth in this seclion. Subd.Z. Information required to be given individual. An individual asked to supply pri��ate or confidential data concerning himself shall be informed ot: (a)the purpose and intended use of the requcsted data within the collecting state agency,political subdivision,or statewide system;(b) whether he may refuse or is Iegally required to supply thc requested data;(c)any known consequence arising from his supplying or refusing to supply private or con�dential data;and(d)the identity of odier persons or entitics authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement of(icer. The commissioner of revenue may n�ace the notice required under tl�is subdivision in the individual income tax or nroperh�tax refund instructions instcad o(on those forms. Subd.3. Access to data by individual. Upon request to a responsiblc authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or confidentiaL Lfpon 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 that data. After an individual has becn sliown the private data and informed of its mcaning,the data need not bc disclosed to him for six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has becn collected or crcated. The responsible aulhority shall provide copies of thc private or public data upon requcst by the individual subject of the data. The responsible authority may require the requcsting person to pay thc actual costs of making,certitying,and compiling the copies. The responsible authority shall comply immediately,if possible,with any requcst made pursuant to this subdivision,or within five days o(the date of the request,excluding Sa[urdays,Sundays and Iegal holidays,if immediate compliance is not possible. If he ca�uiot comrly with the request within that time,he shall so inform the individual,and may have an additional five days within which to comply�vith the request,excluding Saturdays,Sundays and legal holidays. Subd.4. P�rocedure when data is not accurate or complete. An individual may contest t6e accuracy or completeness of public or private data concerning himsclL 7'o exercise this right,an individual shall notify in writing the responsiblc authority describing the naturc of lhe disagrcemenL Thc responsible authority shall within 30 days eithci: (a)correct the data found to be inaccurate or incomplete and attcmpl to notify past rccipicnts oT inaccw-ate or incomplete data,including recipicnts named by the individual;or(b)notify the individual that he bclieves the data to be correct. Uata in dispute shall be disclosed only if the individual's statement of disagrcement is included with the disclosed data. Thc detcrmination of thc responsiblc authority may bc appcaled pursuant to thc provisions of the administrativc procedure act rclating to contested cascs. DA"CA PI2IVACY ADVISORY In accordance with M.S.13.04,Subd.2,"Rigltts of subjects of data",we�vould like to inform you that your request f'or a pernut or license from the City of Orono or any of its departments may require you to furnish certaiu private or contidential information. You are notified that: 1. The inl'ormation 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 tl�e permit 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 req�ested permit or license requires Cowicil action to approve, some information may becoine 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. v�,� � S ,�,,, 1'/f First Middle Last � � � ,� � � . �/�I--�n��7�S �-� _ �� Address V1� � r��', S �� 6'1� }�-' S��:�� t+ C�S �- - �17d- - �� City State Zip Phonc I understand my ri ts as stated above. "� � " Signature