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, � . Sec.13.04 RIGHTS OF SiJB.7ECTS OF DaTA Subd. l. Type of data. The ri¢h�s 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 indicidual. r�.n individual asked to supply private or conFdendal data concerning himtelf shall be infortned of: (a) the purpose and intended use of the requesced data within the colleccing State agency, poliecal subdivision,or sratewide system; (b)whether he may refuse or is legally required to supply the requested data;(c)any Irnown consequence arising from 6is supplying or refusing to supply • private or confidendal data;and(d)the idenriry of other persons or enoaes authorized by state or federal law to receive the data. This requiremeot shall not apply when an individual is asked to supply invesdeative data,pursuant to section 13.82, subdivision 5, to a law enforcement officer. - The commissioner of revenua mav place the noace reauired under this subdivision in the individual income tax or propertv tax refund instruuions ins[ead of on those forms. Subd. 3. Access to data by individual. Upon reques�to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals, and whe�he�it is classified as public, private or conFidential. Upon his further request, an individual who is the subject of stored private o�public da[a 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 chat da[a. After an individual has been shown the priva�e data and informed of its meaning, the data need not be disclosed to him for six months thereafter unless a dispute or acrion pursuant to �his section is pending or addirional data on the individual has been collected or creaced. 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 costs of making,certifying,and compiling the copies. "Ilie responsible auchority shall comply immediately, if possible, wi[h any request made pursuant to this subdivision,or within five days of the date of the request,excluding 5acurdays.Sundays and le¢al holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addicional five days within which to comply wirh the request,exctuding 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�his right,an individual shall norify in writing the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)corrsct the data found to be inaccurate or incomplete and attempt to nodfy past recipients 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 determinarion of the responsible authoriry may be appeafed pursuant to the provisions of the administrative procedure act relaang to contesred 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. The information 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 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 Councii action to approve, some information may become public. 5. You have certain rights under N1.S. 13.04 (available upon request) to review private data on yourself. 6. Your full name is required to process this application or permit. �� C�� First Middle Last '7�C� � L.C��.� `'� � Address i,Uc�-c� ,�� //l�c� ;��>�� 7-� ;��S/ . Ci�y 5tate Zip Phone I understand my rights as stated above. � � ��ifil - - C�,,�. � Signanire