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Sec.13.04 RIGH'TS OF SUB.TECTS OF DATa � Subd. 1. Type of data. The righ[s of individual on whom the data is scored or to be scored shall be as set forth in this section. Subd.2. Information reqirired to be given individnal. An individual asked to supply private or confidendal dara canceming himself shall be informed of: (a)the purpose and inunded use of the requesred data within the collecting�ta[e agency,poliacal subdivision,or statewide sysum; (b)whether he may refuse oY is legally required to supply the requested data;(c)any lrnown consequence arising from 6is supplying or refusing to supply priva�e or confidendal data;and(d)[he idendty of orher persons or enuaes authorized by state or federal law to receive the data. This requ'uemenc shall not apply when an individual is asked to supply invesrigadve data,pursuant co section 13.82, subdivision 5,to a law enforcement officer. The commissioner of revenue mav place the nodce rewired under this subdivision in the individual income tax or provertv tax refund inscruccions instead of on chose forms. Subd. 3. Access to data by individual. Upon requesc to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whe�er it is classified as public,private or confidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown[he data wirhout any charge to him and,-if he desires,shall be infomied of the content and meaning of[hat data. Aher an individua!has been shown the private data and informed of its meaning,the data need not be disclosed to hicn for six months thereafter unless a dispute or action pursuanc to this secdon is pending or addidonal data on the individual has been collected oc created. The responsible authoriry shatl provide copies of the private or public data upon request by the individual subject of che data. The responsible authority may require the requesring person to pay the actual costs of making,ceroifying,and compiling the copies. The responsible authoriry shal(comply immediately,if possible,wich 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 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 concerning himself. To exercise chis right,an individual shall nodfy in wriang the responsible authoriry describing�he nature of the disagreement. The responsible authority shall within 30 days either: (a)correct the data found to be inaccucate or incompiete and attempt to nodfq past recipients of inaccurate or incomplete data, inciuding recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data in dispu[e shail be disclosed only if the individual's statement of disagreemenc is included with rhe disclosed data. The decerminarion of the rzsponsible authoriry may be appealed pursuant to the provisions of the administiarive procedure act reladng to contested cases. DATA PRNACY 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 fumish certain private or confidential information. You are 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 pemut or license. 3. The information may be shared 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. �(x,�,h Qo�c,p� `1c� I�u r � First Mid le Lasc oZ:(Q C� � L�� L Addjress � / l� 353 3/ C , T7� d �� /�`�� /�.r� 1 ��7�`�- City State Zip Phone I understand y rights as stated above. U Signamre �