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� . ! Sec.13.04 RIGH'TS OF SUBJECTS OF DATA Subd. 1. Type of data. The righrs of individual on whom the data is stored or to be stored shall be as sec forth in this secdon. Subd.2. Information required to be given individual. P.n individual asked to supply private or co�dendal data concerning himself shall be informed of: (a)[he purpose and intended use of the requested data wi[hin the collecring'sta[e agency, poliacal subdivision,or statewide system; (b)whether he may refuse or is legally required to supply the requesced data;(c)any lmown consequence arising from his supptying or refusing to supply private or confidendal data;and(d)the idendry of o[her persons or enddes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to suppty investieadve data, pursuant ro secrion 13.82, subdivision�, to a law enforcement officer. The commissioner of revenue mav place the norice required under this subdivision in the individual income tax or propertv tax refund instrucrions instead of on those forms. Subd. 3. Access to data by individual. Upon reques[to a responsible au[horiry,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. 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 contenc and meaning of that data. After an individual has been shown the private data and informed of irs meaning,the data need not be disclosed to him tor six months thereafter uciless a dispute or action pursuant to this secaon is pending or additional data on[he individual has been collected or crea�ed. The responsible authority shall provide copies of the private or public data upon request by[he individual subject of the data. The responsible authorirv may require the requesting person to pay rhe actuai cosu of making, cettifying, and compiling the copies. The responsible authoriry shall compiy immediately, if possible, wi[h any request made pursuant to this subdivision,or within five days ot the date of the request,excluding Saturdays,Sundays and legal holidays, if immediate compliance is no[possible. If he cannot comply with the requzs� within that time,he shall so infornt[he individual,and may have an addidonal five days within which to comply with the request,excluding Saturda}s, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may con[est the accuracy or completeness of public or private data concerning himself. To exercise[his right,an individual shali no[ify in wri[ing the responsible authority dzscribing the nature of the disagreemen[. The responsible authoriry shall within 30 days either. (a)correc[[he data found to be inaccurate or incomplete and attempt to no[ify past recipienrs of inaccurate or incomplete data, including recipienu named by the individual; or(b)noGfy 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 deterntination of the responsible authoriry may be appea(ed 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 cenain private or confidential information. You are notified that: 1. The information you fumish will be used to deternune your qualification for the permit or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the pernut or license. 3. The information may be shared with other local, state or fedecal 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. � -- . � . .., � �_ }_ J � t / � <• .1._'. _1�. ��. Firs[ �tiddle Last �/) -' 1"v1� � _t :: _..- _ � .f-, Address -� /�' ,-�1 � �� l'L�,�: ;" ;�� ,-� � � , . � l(_ I ��h, State Zip Phone i I understand my rights as s�ted above. i " � �� � � i�_ Signamre , � � �� —_�..-�