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, � . Sea 13.04 RIGHTS OF SiJBJECTS 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 secaon. Subd.2. Informarion required to be given individual. An individual asked to supply private or co�dendal data conceming himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,polidcal subdivision,or statewide system;(b)whecher he may refuse or is legally required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing ro supply priva�e or confidendal dara;and(d)the idenary of other persons or enades auchorized by state or federal law to receive[he 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 ertforcement o�cer. "Ihe commissioner of revenue mav olace the notice reauired under this subdivision in the individual income taz or orooertv tax refund instrucrions!nstead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry, an individual shall be informed whether he is the subject of stored data on individuais,and whether it is classified as public,private or co�denrial. Upon his further request,an individual who is the subject of scored privace or public data on individuals shall be shown the data without any charge to him and,if he desires,shall be informed of the contenc and meanin�of that data. After an individual has been shown the private data and informed of its meaning, the data need noc be disc(osed co him for six months thereafter uniess a dispute or acdon pursuant to this secoon is pending or addirional data on the individual has been collected or created. The responsible au[horiry shall provide copies of the private or public data upon request by the individual subject of the data. The responsibie authoriry may require the requesring person to pay the actual costs of making,cer[ifying, and compiling the copies. The responsible authoriry shall comply immediately,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 che request wi[hin that time, he shall so inform the individual, and may have an addidonal five days wichin 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 daci concerning himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. The responsible authority shall within 30 days either: (a)correc[the dara found to be inaccurate or incomplete and attempt to nodfy past recipients of inaccurate or incomplete data,including recipienu named by the individual;or(b)noafy the individual that he believes the data [o be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determinadon of the responsible authoriry may bz appealed pursuant to the provisions of the administraave procedure act relatin� 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 [hat: 1. The information you furnish will be used to determine your qualification for the permi[ or license requested. 2. You may refuse co supply data, bu[refusal may require that the City deny the permit or license. 3. The information may be shared with ocher local, state or federal agencies to [he extent necessary to process the permit or license. 4. If your requested pemut 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. ��Oh n 1 r��c�-r�Ce- �rnecs First 'ddle Lasc _. �(. '� �ddress �r v �t 0 /��' .`��35� �pla1- �Cdo'��`-0 g C��Y State Zip Phone I understan rights as stated above. Signamre , 6 . i �