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+ � Sec.13.04 RIGHTS OF SUBJECTS OF DaTA Subd. 1. Type of data. The righrs of individual on whom[he data is s[ored or to be stored shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenaal data concecning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting'state agency,political subdivision,or sratewide system; (b)whether he may refuse or is legally required to supply the requested data:(c)any known consequence arising from his supplying or refusing to supply private or confidendal data;and(d)the idendty of other persons or enrides authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked co supply invesrieadve dara, pursuant ro secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav place the noace reauired under this subdivision in the individual income tax or propertv tax refund instructions instead of on those forms. Subd. 3. Access to data b�indi�ldual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals, and wherher i[is c(assified as public, priva[e or confidenaal. Upon his further request, an individual who is the subject of stored private or pubtic data on individuals shall be shown che data wichout any charge to hirn and, if he desires, shall be informed of the content and meaning of that data. Afrer an individual has been shown the privace data and informed of its meaning,the data need not be disclosed[o hun for six months thereafter unless a dispute or acrion pursuant to this secdon is pending or addidonal data on the individual has been collected or created. The responsible auchoriry shall provide copies of the private or public data upon requesc by the individual subject of the data. The responsible authoriry may require the requesting person to pay the actual cosu of makine, certifying; and compiling the copies. The responsible authoriry 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 canno[comply with the request within that time,he shall so inforrtt the individual,and may have an addidonal five days within which to comply with the request,exciuding 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[his rieht,an individual shall nodfy in writing the responsible authoriry describing�he na[ure of the disagreement. The responsib(e authoriry shall within 30 days either: (a)cortect[he data found to be inaccurate or incomplete and attempt to nodfy past recipienu of inaccunte or incomplete data, including recipients named by the individual: or(b)noufy the individual that he believes the data to be correct. Data in dispute shali be disclosed only if the individual's statement of disagreement is included with the disclosed data. The de[ermina[ion of the responsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act reladng to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Riahts 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 furnish certain private or confidential information. You are 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 the City deny the permit or license. 3, The information may be shared with other local, state or federal agencies to the ex[ent necessary to process the pernut or license. 4. If your requested pernut or license requires Council action to approve, some information may become public. j. 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. ��C�1��1`�� r �'Iti� ��-�,��%� First vfiddle Last /�� ''�=%^/L/G i� ��j- Addresfi j, �/; C" � I{ �: '%f --%`� ','�:. rf� �� �;,�� y, � -- - _ C�n, State Zip Phone I understand my ri;hts as stated above. , - // �� , � �,�/�ti,/'�/,,;''/�—/ .�' !`/�c�'� Signamre �,-� �