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Sec.13.04ItIGHTSOFSUBIECTSOFDATA , f Subdivision 1. Type of data The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Information requited to be given individuaL An rndrvidual asked to supply private or confidential data concerning himself I . sha[l be informed of (aJ the purpose and intended use of the requested data within the collecting state agency,political subdrvision,or statewide system;(b)whether he may refuse or is lega!!y required to supply the requested data;(c)any known consequence arising from his supp/ying or refusixg to supplyprrvate or confidential data;and(d)the identrty of otherpersons or entitres authorized by state orfederallaw to receive the data. This requirement shall not apply when an individual is asked to supply imestigative data,pursuant to sectiox 13.82,subdivrsion S, to a/aw enforcement o�cer. The commrssioner of revenue mav place the notice required under this subdivision in the individual income tax or Droperty tax refund instruc�ions instead ot on those forms. Subd.3.Access to data 6y individuaL Upon request to a responsib[e authority,an individual shal!be injormed whether he is the subject of stored data on individuals,and whether it is classified as public,private or confidentra[. Upon his further request,an individual who is the subject of stored private or pub[ic data on rndividuals shall be shown the data without arry charge to him arrd,if he desires,shall be informed of the content and meaning of that data. AJter an irrdividua[has been shotivn 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�hrs section is pending or additiona!data on the irrdividual has been collected or created. The responsible authority shall provide copies of the private or pub[rc data upon request by the rndivrdua!subject of the data. The responsible authority may require the requesting person to pay the actual costs of making,cert�ing,and compiling the copies. The r¢sponsible authorrty shall comply immediately,if possible,with arry request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. I,f he cannot comply with the request withrn that time,he shall so inform the individual,and may have an additional frve days within which to comply with the request,excludrng Saturdays,Suredays and lega[holydays. Subd.4. Procedure when data is not accurate or complete.An individua!may contest the accuracy or completeness ofpublic or private data concerning himself. To exercise this right, an individuaJ shall not�in writing the responsible authority describixg the ncrture of the disagreemen�. The responsible authority shall within 30 days either: (a)conect the dala found to be inaccurate or incomplete and attempt to not� past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)not�the individual that he belreves 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 administrative procedure act relating to contested cases. DATA PRIVACYADV7SORY 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 arry of its departments may require you to furnish certain private or conftdential information. You are notified that: 1. The information you furnish will be used to determine your qua[ifrcation jor the permit or[icense requested. 2. You may refuse to supply data,but refusal may require that the City derry the permit or license. 3. The informaJion may be shared with other/ocal,state or federal agencies to the extent necessary to process the permit or lrcense. 4. IJyour requested permit or license requires Council action to approve,some information may become public. S. You have certain rights under M.S.13.04(see,follolving page)to review private data on yourself. 6. Your ful!name is required to process this application or permit. PLEASE PRINT .�"�An��S j�f.�Y�/'S C—r/SJ�G/� First Middle Last ��/U /IP��i/fG✓OB.0 �/� Address U/�jNU /�'J� 3��31� L/ City State Zip Phone I understand ry rights ated above. ignature 10