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.� . Sec.13.04 RIGHTS OF SUBJECTS 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 forth in this secdon. Subd.2. Information reqirired to be given individual. P.n individual asked to supply private or confidential data conceming hunself shall be informed of: (a)the purpose and intended use of the requested data wi[hin the collecting"state agency,polidcal subdivision,or statewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any known consequence arising from his supplyin�or refusing to supply private or confidenrial data;and(d)the identity of other persons or enrides authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesdcadve data, pursuant to seccion 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav place the norice reouired under this subdivision in the individual income tax or property tax refund instructions inscead of on those forms. Subd. 3. Access to data by individual. Upon requesc to a responsible authoriry,an individual shall be informed whe[her he is the subject of stored data on individuals, and whecher it is classified as public, private or confidendal. Upon his fucther request,an individual who is the subject of stored private or public dara 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,che data need not be disclosed to hirn for six months thereafter unless a dispute or acrion pursuant to this secaon is pending or additional data on the individual has been collect;l 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 the ac[ual cosrs of makin2, certifying, 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 of the date of the request,excluding Saturdays,Sundays and lega]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 addidonal five days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure w•hen data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shail nodfy in writing the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found ro be inaccurate or incomple[e and attempt to notify past recipienu of inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individual that he believes the data to be correcc. Data in dispute shail be disclosed only if the individual's statement of disagreement is inctuded with the disclosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act relacing 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 to determine your qualification for the pernut or license requested. 2, You may refuse to supply data, but refusal may require that the City deny the permit 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. (. Your full name is required to process this application or permit. �� qG�S "'L.- First Middle Last 39�� L._..�-i��r��4 /��L S - Aaa�� oy �% � � 7�(.a".�� Ciry State Zip Phone I un rst d my rights as st [ed a o e. � - ;_ ��-��-� . �� , Signa re ,