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� . Sec.13.04 RIGHTS 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 tkus secdon. Subd.2. Information required to be given individual. An individual asked to supply private or confidential data conceming himself shap be informed of: (a)the purpose and intended use of the requested data within the cotlecting state agency,poliacai subdivision,or statewide system;(b)whether he may refuse or is legally required to suppiy the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidendal daha;and(d)the identiry of other persons or entities authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data, pursuant to section 13.82, subdivision 5, to a law enforcement o�cer. The commicsioner of revenue mav nlace the norice rewired under this subdivision in the individual income tax or nronertv taz refund instruceons instead of on those forms. Subd. 3. Access to data by individual. Upon request to a respoasible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or confidential.:Upon his further request,an individual who is the subject of swred private or public data on individuals shall be shown the data without any charge to tum and,if he desires,shall be informed of the content and meaning of that data. After 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 dispute or a�fion pursuant to this secaon is pending or addirional data on the individual has been collected or created. The responsible authority shall provide wpies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the actual cosu of making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possible,with-any request tnade pursuant to this subdivision,or within five days of the dat8 of the request,excluding Saturdays,Sundays and legal holidays,if immediate complianoe is not possible. If he carmot comply with the request within that time,he shall so inform the individual,and may have an addidonal 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 concerning himself. To ezercise this right,an individual shall nodfy in writing the responsible authority describing the nature of the ' disagreemecu. The responsible authoriry shall within 30 days either: (a)correct the data foU�i to be inaccnrate or incomplete and attempt to notify past recipients of inaccurate or ii►complete data,including recipienu named by the irxiividual;or(b)noafy the individual that he believes the data to be correct. Data in dispute shall be disclosed oaly if the individual's statement of disagreement is included with the disclosed data. The determinaaon of the responsible authority may be appealed pursuant to the provisions of the administradve procedure act relaang 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�ity of Orono or any of its departments may require you to furnish certain private or confidential information. ` You aze notified that: 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 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. �� /��u �.�X-- �ra 2 6(�r.�l ��'rac..rac�t�r�-- First Middle Last ,(� � `7 �Go 2p '�'� '�St' ��c5 1"'h K.K- JLt,o� 55 � Address 92 Z�/� �f City State Zip Phone I understand my rights stat d above.�, � Signa . 6