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Sec.13.04 RIGH'TS OF SUBJECTS OF D�1TA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set fotth in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenaal data conceming himself shall be informed of: (a)the purpose and iatended use of the requested dara within the collecting'state agency, poliacal subdivision,or sratewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any Irnown consequence arising from tus supplying or refusing to supply private or confidenaal data;and(d)the idenriry of ocher persons or enrides authorized by state or federal law to receive the data. This requ'uemenc shall not apply when an individual is asked to suppty invesrieadve data, pursuanc to secdon 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of re�enue mav place the norice reauired under this subdivision in the individual income tax or propertv taz refund instruc[ions inscead of on those forms. Subd. 3. Access to data by indiridual. 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, private or confidenrial. Upon his funher request, an individual who is the subject of scored private or public data on individuals shall be shown the data wichout any charge to hun and, if he desires, shall be informed of the content and meaning of�hat data. Afrer an individual has been shown the privace data and informed of i[s meaning,che data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this secdon is pznding or addiaonal data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon requesc by the individual subject of the data. The responsible authoriry may require the requesring person to pay che actual cosu of making, certifying, and compiling the copies. The responsible authoriry shall comply immediately, if possible, wich any request made pursuant to this subdivision, or wi[hin five days of the date of che requesc,excluding Saturdays,Sundays and lega]holidays,if immediace compliance is not possible. If he cannot comply with the requesc within that time,he shall so inform the individual,and may have an addirional 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 comp(eteness of public or private data concerning himself. To exercise this right,an individual shall nodfy in wridng the responsibie authoriry describing che nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attemp�to noafy past recipienu of inaccurate or incomplete data, including recipients named by che individual; or(b)noafy the individual that he believes the data to be correct. Data in dispute shail be disclosed only if the individual's statement of disagreement is included with the disciosed data. The determinaaon of the responsible auchoriry may be appealed pursuanc to the provisions of the administradve procedure act reladng 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, The information you furnish will be used ro 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 pernut 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. V � � - _ � ,��_ Q �C��\J�.�._ First titiddle � ast �� \��1�� \L O'F�.� Ad�sJ\U�� \ `�`�-� ��S_�� `��_ �Z. l v Cin, -- Sta[e Zip Phone � I und�rstan m �ght'as st t � �above. Signantre