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� , _ ,. , Sec.13.04 RIGHTS OF SfJBJECTS 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 this section. S�bd.2. Information reqirired to be given individual. An individual asked to supply privau or confidenaal dara conceming himself shall be mformed of: (a)the purpose and intended use of the requested data within the collecting state agency,polidcal subdiPision,or statewide system; (b) whether he may refuse or is legally required to suppiy the requested data;(c)any Imown consequence arising from his sapplying or refusing w supply privaLe or confidenaal dara; and(d)the idendry of other persons or entities authorized by state or federal law to receive tbe data. This requirement shall not apply when an individual is asked to supply investigadve data,pursuant to section 13.82,subdivision 5,to a law enfio�ement officer. The commissio�r of ievern►e mav nlace the notice tewired under tius subdivision in the individual income taz or oronertv taz�efund insttucdons instead of on those forms. Subd.3. Access to data by mdividual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of srorefl data on udividuals,and whether it is c�ed as�blic,private or confidential. Upon his further request,an individnall who is the subject of stored private or public data on individuals shall be shown the data without any chazge to him and, if he desires, shall be infocmed 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 siz months theteataer unless a dispuee or action pursuant to dris secdon is peading or additional data on the individual has been collecsd or cieated. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The respo�ble authoriry may require the requesting person to pay the acwal cosu of making,certifying,and compiling the copies. The cesponsble authority shall comply immediately, if possible,with any roquest made pursuant to this subdivision,or within five days of the date of the request,excluding Sawcdays,S�ndays and legal holidays,if immediate compliance is not possible. If he cannot�mply with the request within d�at time,he shall so inform the individual,and may have an additional five days within which to comply with the ieques�excluding Saturdays,Sundays and legal holidays. ', Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or complzseness of public or private data conceming himself. To exercise this right,an individual shall noafy in writing the responsible authority describing the�re of the disagreement. The responsble authoriry shall within 30 days euher. (a)correct the data found to be inacwrate or incomplete and attempt to nodfy past iecipients of inaccurate or i�omplere data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The detemrinauon of!he responsi'ble authoriry may be appealed pucsvant to the pmvisions of the administretive procedure 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 City of Orono or any of its departments may require you to fiunish 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 permit or license. 3. The informarion may be shazed with other local, state or federal agencies to the eztent 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 pri�ate data on yourself. 6. Your full name is required to process this application or permit. Z I// �E/3.o✓dc<� First Middle Las� 35�.� �r�� ..-,i Address �t ��.-ni/Z�—,,lc-� ./(.t•..< �J�� '3� —0��.::g Ciry State Zip Psone I understand m rights as stated above. %� � Signature 10