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I . , Sec.13.04 RIGHTS OF SIJBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be atored shall be as set forth in this section. Subd.2. Information required to be given indivldual. An i�ividual asiad to supPly private or confidendal data conceming himself shall be informed of: (a)the purpose and i�ended use of the requested data within the collecdng state age�y,political subdivision,or statewide system;(b)whether he may refuse or is legally required to supply the requested data;(c)any known consequeace arising from his supplying or refusing to supply private or confidential data;azd(d)the identiry of otl�r persons or entities authorized by state or federal taw to receive the data. 11us requirement shall not apply when an individual is asked to supply invesdgative data,pursuant to section 13.82, subdivision,5, to a law enforcement officer. The co R+issio�r of reve�e m�v nlacp the notice reauired under this subdivision in the individual income taz or nrocertv taz refund inc�ctions instPad of on tho�fornL. Subd.3. Acces.c to data by individual. Upon request to a responsible authoriry,an i�ividual 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 stored private or pubiic data oa individuals shall be shown the data without azry charge to lvm a�,if he desires,shall be informed of the content and meaning of that data. After an individual has been shown the private data aiul informed of its meaning,the data need not be disclosed oo him for six months thereafter unless a dispute or ac6on puisuant to this section is pending or additional data on the individual has been collected or creaud. The responsible authority shall provide copies of the privaoe or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual costs of maldng,certifying,and compiling the copies. The responsible authority shall comply immediately,if possible,with any request made pursuant co this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate complia�e is not possible. If he cannot comply with the request within that time,he shall so inform the inciividual,and may have an addiaonal five days within wtuch to comply with the request, ezcluding Saturdays,Sundays and legal holidays. S�bd.4. Procedure whw data is not accurate or complete. An individual way contest the accuracy or completeness of public or private data conceming himself. To exercise this right,an ndividual shall notify in writing the responsible authority describing the nature of the disagree��. The responsible authority shall within 30 days either. (a)wrrect the data fa�nd to be inaccurate or incomplete and attempt w�rify past recipierns of inaccuiate or incoa►plete data,i�luding recipients named by the individual;or(b)notify ihe individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is i�luded with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the admiaistra6ve prceedure act relating 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�iry 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 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 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. /�� /�� Z '~ ��r/�i��- F � � _ � Mi � L � �� Add s s-��y �� .�a� Ciry State Zip Phone I understand my ri as stated above. s' aue 6