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� Sec.13.04 RIGHTS OF SLJB.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 fonh in this secaon. Subd.2. Information required to be given individual. �.n individual asked to supply private or confidendal data concerning himself shall be informed oE (a)the purpose and intended use of the requested data wirhin tbe collecting'state agency, polidcal subdivision,or statewide system; (b)whether he may refuse or is legalty required to supply the requested data;(c)any Imown consequence arising from his supplying or refusing to supply private or confidendal data;and(d)the idenury of other persons or entiaes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply inves[igaave data, pursuant to secaon 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of revenue mav place the noace required under this subdivision in the individual income tax or prooertv tax refund instrucrions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible au[horiry,an individual shall be informed whether he is the subject of stored data on individuals, and whether it is classified as public, private or co�dential. Upon his further request, an individual who is the subject of stored private or pub(ic data on individuals shall be shown the data wi[hout any charge to him and, if he desires, shall be informed of the content and meaning of that data. Afrer 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 dispure or action pursuant to this secdon is pending or additional data on the individual has been collected or creaced. The responsible authoriry shall provide copies of the private or public data upon reques[by the individual subject of the data. The responsible authoriry may require the requesting person to pay the actual costs of making, cerafying, and compiling the copies. The responsible authoriry shall comply immediate(y, 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 immediate compliance is not possible. If he cannot comply with the reques� within chat time,he shall so inform[he individual,and may have an addidonal five days within which to comply with the cequest,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 himself. To exercise this right,an individual shall no[ify in writing the responsible authority dzscribing the nature of the disagreemenc. The responsible authoriry shall within 30 days ei[her: (a)correct the data found to be inaccunte or incomplete and attempt to nodfy 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 correct. Data in dispute 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 rela[ing 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 pemut or license requested. 2. You may refuse to supply data, but refusal may require that the 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 pernut or license. 4. If your requested permit or license requires Council action to approve, some information may become public. 5. You have certain righ[s under M.S. 13.04 (available upon request) to review private data on yourself. fi. Your full name is required to process this application or permit. '�.�1-l� � �c � ��e�1 ��:� �� l First btiddle Last `�7 YS ��y � l Address �;/�c�.--o— _ �-� jJ��/ y ��—G> > .� ��, State Zip Phone I understand my ' ts as stated abo��. �, / � %✓�'Lti � Signature