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,� • i • ti, Sec.13.04 RIGH'TS OF SUB.TECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set for[h in this secaon. Subd.2. Information required to be given individual. An individual asked to supply private or confidendal data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting'state aeency, polidcal subdivision,or statewide system; (b)whether he may refuse or is legally required to supply the requested data:(c)any lmown coasequence arising from his supplying or refusing to suppiy privace or confidenaal data;and(d)the idenriry of other persocvs or endaes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesrigative data, pursuaat to secrion 13.82, subdivision 5, to a(aw enforcement officer. The commissioner of revenue mav place the no[ice required under this subdivision in the individual income tax or propertv tax refund instrucdons instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals, and whecher it is classified as public, private or confidential. Upon his furrher request, an individual who is the subjec� of stored private or public data on individuals shall be shown�he data wichout any charge to him and, if he desires, shall be informed of the con[ent and meaning of that data. After an individual has been shown 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 this section is pending or addidonal data on the individual has been collected or created. The responsible authority 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. The responsible authoriry shall comp(y immedia[ely, if possible, with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediare compliance is no[possible. If he cannot comply with the reques[ within that time,he shall so inform the individual,and may have an addidooal 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 contes[the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correc[the data found to be inaccurate or incomplete and attemp[to nodfy past recipie�ts 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 disc(osed only if the individual's statement of disagreement is included with the disclosed data. The detzrmination of the responsible authoriry may be appealed pursuant to the provisions of the administrative 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 pernut 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 fumish will be used to determine your qualification for the pemut or license requested. 2. You may refuse to supply data, but refusal may require that [he City deny the pernut or license. 3. The information may be shared with other local, state or federal agencies to the extent necessary to process the pemut or license. 4. If your requested pernu[ 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 c �» t�( AN �� First Middle Last �(I�'� �-F�G �u-ocp r-'c;�rD Address - ��,��`, �M,�, S> :_: f, � y , _ ; �^ �� Ciry State Zip Phone I understand right�'as stated above. 'c—� _ � ��---- . � Signantre