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� , , Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individuai oa whom[he data is stored or to be scored shall be as set forrh in this secrion. Subd.2. Information reqiared to be given individual. An individual asked to supply private or confidendal data conceming himself shall be informed of: (a)the purpose and in[ended use of the requested data wichin the collecting§race agency,poliacal subdivision,or statewide system; (b)whether he may refuse or is legally roquired to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply private or confidendal da[a;and(d)the identiry of ocher persons or enaties authorized by state or federnl law to ceceive the data. This requirement shall not apply when an individual is asked to supply invesagacive data,pursuan[[o secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav alace the nodce required under this subdivision in the individual income tax or propertv tax �efund instrucdons instead of on those forms. Subd.3. Access to data by indiridual. Upon requesc to a responsible aurhority,an individual shall be informed whether he is the subject of stored data on individuals,and wherher it is classified as public,private or confidential. Upon 6is further request,an individual who is the subject of stored private or public dara on individuals shall be shown the data wirhout any charge to him and,�if he desires, shall be informed of the content and meaning of that data. After an individual has beea shown the privace data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action punuant to this secdon 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 roquest by the individual subject of the data. The responsible authoriry may require the requesting person to pay the actuai costs of making,cemfying,and compiling the copies. The responsible authoriry shall comply immediacely,if possibie,with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saardays,Sundays and legal holidays,if immediate compliance is noc possible. If he cannot comply with the requesc within that time,he shall so inform the individual,and may have an additional 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 completeness of public or private data concerning himseif. To exercise this right,an individual shall norify in writing ihe responsible authoriry describing the nature of the disagreement. The responsible authority shali within 30 days either: (a)correct the data found to be inaccumte or incomplete and attempt to nodfy past recipiencs of inaccurate or incomplete data, including recipients named by the individual;or(b)notify ihe 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 disclosed dara. The determinadon of the responsible authority may be appeated pursuant to the provisions of che adminisaative procedure acc relating to contesced 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 fumish certain private or confidential information. You are notified that: 1. The information you fumish 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 permit or license. 3. The information may be shazed with other local, state or federal agencies to the eztent 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. .._� ,,, � - c. ..r�2>�✓�- First —1 , � 5 S ��N? �ff lie�'/ `� asc • , Addres� /`� �i 1�r� o , /�/L /l� �S�� '�`��._a �� C�ry State Zip Phone I understand my rights as stated above. �� Signam