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� y Sec.13.04 RIGH'TS 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 section. Subd.2. lnformation reqlrired to be given individual. An individual asked to supply private or confidenrial data concerning himself shall be informed of: (a)the purpose and incended use of the requesred data within the collecting State agency,polidcal subdivision,or stacewide system; (b)whether he may refuse ot is legaliy required to supply the requested data;(c)any lmown consequence arising from his supplying or refitsing to supply priva[e or confidendal data;and(d)the idendry of o[her persons or enudes au[horized by state or federai law to receive the data. This requirement shall not apply when an individual is asked to supply investigadve data,pursuant to secdon 13.82, subdivision 5,to a law enforeemenc o�cer. The commissioner of re�enue mav place the nodce recluired under this subdivision in the individual income tax or propertv tax refund instrucdons inscead of on those forms. Subd.3. Access to data by individuai. Upon request to a responsible aurhoriry,an individual shall be informed whether he is the subject of stored data on individuais,and whe[her it is class�ed as pubiic,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 without any charge to him and,-if he desires, shall be informed of the content and meaning of[hat data. Afcer an individual has been shown the privau data and informed of ics meaning,the data need not be disclosed to him for siz months thereafter unless a dispuce or action pursuant to [his secrion is pending or addidonal data on the individual has been collected or created. The responsible authoriry shall Qrovide copies of the privace or public data upon request by the individual subject of the dara. The responsible authoriry may require the requesdng person to pay the acrual cosu of making,ceroifying,and compilin8 the copies. The responsible auchoriry shall compiy immediately, if possible,with any request made pursuant to chis subdivision,or wi[hin five days of the date of the request,exciuding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the requesc within that time,he shall so inform the individuai,and may have an additional five days within which to comply with the request,excluding Saturdays, Sundays and lega(holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private dara concerning himself. To exercise this right,an individual shall nodfy in wridng the responsible authoriry describing the nature of the disagreement. 'IT�e responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of inaccurate or incomplete data, inciuding recipients named by the individual;ar(b)notify ihe individual that he believes the dara to be correct. Data in dispuce shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relating to contested 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 permit or license from the City of Orono or any of its departments may require you to furnish certain private or confidential information. You aze notified thar. 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 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. g. 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. �i4 d�t�S /1,l.��r r nJ j,�/h�r 7� First Middle Lasc �3 S!b ..�-�v y z.��- G-' Address M� ,�5� `'ll �{�(—O (.�� aN� City State Zip Phone I understand my rights as stated above. � ��. Sig re