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v Sec.13.04 RIGFTTS OF SCJBJECTS OF DATA Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information req�rired to be given individual. An individual asked to supply private or confidendal data concerning himself shail be informed of: (a)the purpose and in[ended use of the requesied dara within the collecang'state agency, poliacal subdivision,or sratewide system; (b)whether he may refuse o'r is legally required to supply the requested dara;(c)any laiown consequence arising from his supplying or refusing to supply private or confidential data;and(d)the idendry of other persons or endaes aurhorized by state or federel law to receive[he data. This requirement shall not apply when an individual is asked to supply invesrieadve data,punuanc to secdon 13.82, subdivision 5, to a law enforcement ofFicer. The commissioner of revenuc mav place the nodce required under this subdivision in the individual income tax or properry raz refund instrucdons instead 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 stared data on individuais,and whether it is c(assified as public,private or confidenoal. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown che dara wiehout any charge to him and,�if he desires, shall be informed of the contenc and meaning of chat data. Aher an individual has been shown[he private data and informed of its meaning,the dara need not be disclosed to him for six months thereafter unless a dispute or acaon pursuant w this secdon is pending or additiona(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 subjecc of the data. The responsible authoriry may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authoriry shall comply immediately, if possible,with any requesc 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 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 conceming himself. To exercise this right,an individual shall nodfy in wridng the responsible authoriry describing the nature of the disagreement. The responsible au�horiry shall within 30 days either: (a)correct the data found[o be inaccurate or incompiece and attempt to nodfy past recipients of inaccunte or incomplete data, including recipients named by ehe individual;or(b)notify the individual thac he believes the data to be correc[. Data in dispuce shall be disclosed only if the individual's statemenc of disagreement is included with the disclosed data. The determinaaon of the responsible auchority may be appealed pursuanc to the provisions of[he adminisaadve procedure act reladng 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 pemut or license from the City of Orono or any of its departments may require you to fumish certain private or confidential information. You aze 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 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. 6. Your full name is required to process this application or permit. �,a�, `�� R.�, �Co�f �n�p�£2. First M�ddle Last 3s�o � P��c� Ad res � �, � r �( . r � /�iU � co Ci ° State � Zip Phone ; ' I u � t �ny ri hts s ated above. � � �� Signa r �� \