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� Sec.13.04 RIGHTSOFSUBJECTSOFDATA Subdivision 1. Type ojdata The rights of individua!on whom!he data is stored or to be stored shall�be as set forth in this section. Subd.2. Infornwtlon required to be given individuaL An rndividual asked to supply prrvate or coxfidentia!data concerning himself shal!be informed of (aJ the purpose and intended use of the reguested data within the collectrng srate agency,political subdivision,or statewide . system;(b)whether he may re.J'irse or rs legally requrred to supply the requested data;(c)axy/orown corrsequence mising from his supplying or sefusing to supply private or confrdential data;and(d)the identity of other persorrs or entities authorrzed by state or federal law to receive the data. This requirement shall not apply when ax individual rs osked to supply irrvestigative data,pursuant to section 13.82, subdivisron S, to a law enforcement officer. The commissioner ofreverrue mav place the notice reouired under this subdivision in the individual income tax or Droper�v tax refur+d instructioru instead oton those torms. Subd.3.Access to data by individuaL Upon request to a responsible authority,an individua!shal!be informed whether he rs the subject of stored data on individuals,and whether it is classrfted as publrc,private or confrdenlral. Upon hrs further request,an individua!who is the subject of stored prrvate or public data on individuals sho11 be shown the data wi�hout any charge to him aud rf he desires,shall be informed of the content and meaning of that data. After an rndividua!has been shown the private data and informed of its meaning, the data need not be disclosed to him for srz months thereafter unless a dispute or actron pursuant to this section is pending or additional data on the rndividual has been collected or created The responsible authority shall provide copies oJthe prrvate or public data upon request by the individua[subject of the data. 77re responsible authority may require the requesting person to pay the actual costs of making,cert�ing,and compiling the copres. The resporrsible authority shal!comply immediately,if possible,with any request made pursuant to rhis subdivisron,or within frve days of the date oJthe sequest,excluding Saturdays,Sundays and[egal holidays,if immediate complrance is not possib[e. If he cannot comply with the reguest within thaf time,he shall so inform the individual,and may have an additionalfive 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 rndividual may contest the accuracy or completeness ofpublic or private data concerning hrmself. To exercise this right, an individual shall not�in writing the responsible authority describing the nature of the disagreement. The responsible aulhority shall within 30 days either: (a)correct the datafound to be inaccurate or incomplete and attempt to not� past recipients of inaccurate os incomplete data,including recipients named by the individual;or(b)not�the individua!that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of drsagreement is included with the disclosed data. The determrnation ojthe responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating ro conresred cases. DATA PRIVACYADVISORY In accordance with M.S.13.04,Subd.2,"Righls ofsubjects ofdata';we would like to inform you thatyourrequestforapermit orlicense from the City of Orono or arry of its departments may require you to furnish certarn private or confedential injormation. You are notifred that: 1. The rn,jormation 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 derry the permit or license. 3. The information may be shared with other local,state or federal agencres to the extent necessary to process the permi�or license. 4. If your requested permit or license requires Council action to approve,some inj'ormatron may become publrc. 5. You have certain rights under M.S. /3.04(see following page)to review private data on yourse[f. 6. Your full name is required to process this application or permit. PLEASE PRINT ��W� � �l��I.er� First Midd[e Last �3�F3� W �Z� (Oti Address rn�l� h,�,c." �s�� City State Zip Phone �L �l��6'��-�r� I understa d rig s as stated above. Sr ure 10