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Sec.(3.04 RIGHTS OF SIJBJEC'I'S OF DATA Subd. 1. Type of data. Th� rights of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd. 2. Informatio.n required to be given individual. M individual asked to supply private or confidential data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the coilecring State age�cy, political subdivision,or statewide rysttm; (b)whe�her he may refuse or is legally required to supply the requested data;(c)any known consequence arising frotn his supplying or refusing to�upply private or confidenrial data;and(d)the identity of other persons or entities authorized by state or fede�a!law to receive the data. "Ihis�equiremont shall not apply when an individual is asked to supply invesdgaove data, pursuant to section 13.82, subdivisioa S, to a law enforeemenf officer. The commissioner of revenue ma lace the notice re uired under ehis subdivision in the individual income tax or ro taz refund instrucaons instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or contidendal. Upon his further request,an individual who is the subject , of stored private or public data on individuals shall be shown the data without,any c6arge to him and, if he desires, shall be informed of the coutent and meaning of that data. Afur�an individual has been shown the private data and informed of its meaning,che data need not be disclosed to him for six months thereafur unless a dispute or action pursuant to this section is pending or addidonal daa on the individual hu been collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. 'Ibe responsible authority may require the requesting person to pay the actual costs of making, cettifying, and compiling the copies. The responsible authority shall comply immcdiately, if possible, wirh any rcqu�st mado pursuant to this subdivision,or within five days of the date of the request,ezcluding Saturdays.Sundays and legal holidays, if immediate compliance is not possible. If he cannot comply with the request wichin that time, he shall so infortn the individual,and may have an additional five days within which to comply with the request,ezcluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest ihe accurecy or completeness of public or private data concerning himsdf. To ezet�ise this right,an individual shall notify in writing the responsible authority des:ribing the uature of the disagrcement. The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or fncomplete data, including recipien�s named by the individual; or(b) notify the indicidual 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 decermination of the responsible authoriry may be appzaled pursuan[ro the provisions of the administrative procedure act relaong to ' contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we �vould like to inform you that your request for a permit or license from the Ciry of Orono or any of its departments may require you ro furnish certain private or conFdential information. . You are notified that: I. The information you furnish will be used[o 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 pernut or licease. 3. The information may be�hared with other local, state or federal agencies to the extent necessary to process the pemut 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. ��'��►,.� l S C.-�-�A-�G �r.ID►�I�-1�� First Middle Last i��c v t 1�.i �.t� ��-- �� i C S Address �—�t P��c E r-t►.� 5�.��- �153 q44 e14�t�t c�h s��e Z�P Phone [ nder and my rights s te abo e. � � Signature L�, � �'�/