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. .. Sec.13.04 RIGHTS OF SUBJEC7'S OF DATA Subd. I. Type of data. The rights of individual on whom the data is stored or to be stored shall bc as sei forttt in this section. Subd.2. Information required to be given individual. An individua!asked to supply privau or cortfiderttia!data conceming himselfshall be informed of. (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide systun;(b) whether he may refuse or is legally required to supply the requested data;(c)any Irnown consequence arising from his supplying or refusing W suppty private or confidential data;and(d)the identity of other persons or entities authorized by state or fedeial law to receive the data Tius reyuirement shall not apply when an individuai is asked to suppiy investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. Thc commissioner of rcvenue mayplace the notice required under this subdivision in the individual income tax or property tax refund instructions instead of on those fortns. Subti.3. Access to data by individual. Upon request tn a responsible authority,an individua!shall be informed whether he is the subjectof stored data on individuals,and whether it is classified as public,private or confidential. Upon his furiher request,an individual wtro is the subject of stored private o�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 meaaing of that data. After an ir�ividual has been shown the private data and infortned of its meaning,the data r�eed rwt be disclosed to him for six months thereafter unless a dispute or action pursuant to ihis section is pending or additional data on the individual has been collected or created. The responsible auUwriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possible,with any request made piusuant to this subdivision,or within five days of the date ofthe request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible.If he canrwt comply with the request within that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. 3ubd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data conceming himsel£ To exercise this righ�an individual shall notify in wriUng the responsible authority describing the nature ofthe disagreement.The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipienu of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual Lhat he bel ieves 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 detertnination of the responsible authoriry may be appealed pursuant to the provisions of the administra[ive 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 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 permit or license. 3. The information may be shared with other local, state or federal agencies to the e�ctent necessary to process the permit or license. 4. If your requested permit or license reyuires Counci] 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 applicatiott or pertnit. , �M�� M A��CL�.� First Middle Last Cc�1(r�� t-.�,° ��k-r�9 �c,��}� Address � `�i�)rj;� i.��,a C� f 1 I� � � �53'�� ..�d�z �Q Cc'�> ��,5 7 City State Zip Phone I understand y rights as stated abo e. � SignAture `�--�� -=r---- ... _.,_ ______� _... �. 32 � ��•: �