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� •� � Sec.13.04 RIGHTS OF SUB.TECTS OF DATA Subd. 1. Type ot data. The righcs of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal data concerning himself shall be informed of: (a)the purpose and intended use of the mquested data within the collecting'state agency, polirical subdivision,or statewide system; (b)whether he may refuse or is legally required ro supply the requested data;(c)any known consequence arising fmm his supplying or refusing to supp(y private or confidential data;and(d)the idendry of other persons or endties authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesriearive dara, pursuanc to secdon 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 instrucdons instzad of on[hose forms. Subd. 3. Access to data by individual. Upon request to a responsible auchoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whe[her it is classified as public, priva[e or confidenrial. 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 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 chis secrion is pending or addidonal data on the individual has been collected or created. The responsible authoriry 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 cosrs of making, certifying, and compiling the copies. The responsible authoriry shall compiy immediacely, if possible, with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and leeal holidays,if immedia[e compliance is not 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 private data conceming himself. To exercise this rieht,an individual shall norify in writing the responsible authoriry describing the nature of ihe disagreemen[. The responsible authoriry 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 the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the administrarive 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 furnish certain private or confidential information. You are notified that: 1. 1fie 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 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 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 this application or permit. `_� �� _ 1:��'� l� ti��. First Middle Last � � f�� 1 � � ` � t� i71� �\ — Address � � 5 5�. �; /j �� c. - \_�.'�� —� , ,� ,. � �,._ � City . State Zip Phone I understand my rights as stated above. C _--- , - � - . __ — , �_., '" `„-,� � J�t "'----____ �� Z l j � / Signamre ��