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. � . ,� ' �, Sec.13.04 RIGHTS OF SLJB.fECTS OF DATA Subd. 1. Type of data. The righ[s of individual on whom the data is stored or to be stored shall be as set for[h in this secdon. Subd.2. Information req�rired to be givea individual. An individual asked to suppiy private or confidendal dara concerning himself shall be informed of: (a)the purpose and inrended use of the requested data within the collecting"state agency,polidcal subdivision,or sratewide sysum: (b)whether he may refuse oY is legally required to supply the requesced data;(c)any lrnown consequence arising from lus supplying or refusing to supply private or confidential data;and(d)the identiry of other penoas or entides au[horized by state or federal law to receive the data. This requirement shal! not appiy when an individual is asked to supply invesdgadve dard,pursuanc to section 13.82,subdivision 5,to a law enforeement o�cer. The commissioner of re�enue mav vlace the norice required under this subdivision in the individual income tax or oropertv tax refund instrucrions inscead of on those forms. Subd.3. Access to data by individual. Upon requesc to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whe[her ic is class�ed as public, priva[e or confidendai. Upon his further request,an individuat who is the subjec� of stored private or public daca on individuals shall be shown the data wichout any charge to him and,�if he desires, shall be informed of the content 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 siz months thereafter unless a dispute or acdon pursuan[to [his secdon is pending or addidonal data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesring person to pay che actual costs of making,certifying,and compiling the copies. The responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of the request,exctuding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an additionai five days within wtuch 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 compteteness of public or private data conceming himself. To exercise this right,an individual shall nodfy in wriang rhe responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of inaccurate or incomplete data, including recipients named by[he individual; or(b)nodfy the individua!that he believes 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 determinadon of the responsibte authoriry may be appealed pursuant to the provisions of the administradve procedure act relaang to wntested cases. DATA PRNACY 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 pemut 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 pemut or license. 3. The information may be shared with other local, state or federal 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. �� r f�� 5�, f�w�(/ Fint < <ddle � Last �7p( <fOS�� Add��-�y�.�.l 4 �Q,` 1� ��/ ��7��U ��Y 7 �`l � Ciry State Zip Phone I understand my 'ghts as stated v � ignamre