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Sec.13.04 RIGHTS OF SLJB.TECTS OF DATA Subd. 1. Type of data. The righ[s of individua]on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information required to be given individual. An individual asked to supply private or co�dendal data concerning himself shall be informed of: (a)the purpose and in[ended use of the requested data wi[hin the collecdng'state agency, polidcal subdivision,or statewide system; (b)whether he may refuse or is legally required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply privace or confidencial data;and(d)[he idenary of o[her persons or endries authorized by state or fedecal law to receive the data. This requirement shall not apply when an individual is asked to supply invesogadve daca, pursuant to secaon 13.82, subdivision 5, to a law enforcement ofFicer. The commissioner of revenue mav place the noace required under this subdivision in the individual income tax or propertv tax refund inscrucrions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals, and whether it is classified as public, private or confidenaal. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data without any charge to him and,'if he desires, shall be informed of the conten[ and meaning of that data. Afrer an individual has been shown the private data and informed of ia meaning,the data need not be disclosed to him for six months thereaftec unless a dispute or accion pursuant to this secrion is pending or addiaonal data on the individual has been collected or created. The responsible authority shall provide copies 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 ac[ual costs of making, cerafying, and compiling the copies. The responsible au[hority 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 the reques� within that time,he shall so inform the individuat,and may have an addidonal five days wi[hin which to comply with the request,excluding Saturdays, Sundays and legal hotidays. 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 this right,an individual shall notify in writing the responsible authoriry describing the nature of[he disagreement. The responsible au[horiry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipieacs of inaccurate or incomplete data, induding recipients named by [he individual; or(b) notify the individual that he believes the data to be correct. Data in dispute shall be disciosed only if the individual's statemenc of disagreement is inctuded with the disclosed dara. The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act rela[ing 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 pernut or license from the City 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 pemut or license requested. 2. You may refuse to supply data, but refusal may require that [he City deny the pernut 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. � •/� t'� lr \ First vliddle Last �5 So L �1��r Ss5 -�zt� Address ��,.� S 5 ,� � � / �Z �'� '��g b C��, Sta[e Zip Phone I unders[and my rights as stated above. � — Signature