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Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type o[data. The rights of i�ividual on whom the data is stored or to be stored shall be as set forth in this secaon. Subd.2. Information required to be gIven individual. An individual aslced to supply private or confidendal data conceraing himsetf shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,polidcal subdivision,or stauwide sysum; (b) whether he may refuse or is legally required to supply the requested daffi;(c)any Imown coasequence arising from his supplying or refusing to supply privatc or confidendal data;and(d)the identity of other persons or endties authorized by state or federal law to receive the data. This requuement shall not apply when an individual is asked to sapply investigative data,pursuant W section 13.82, subdivision S, to a law enforcement officer. 'R�e commissioner of cevemie mav olace die notice ieauind under this subdivision in t�e individual income taz or�rocertv tax refund inswctions instead of on those forms. S�►bd.3. Acces to dsta by mdividoal. Upon request w a respoasible authoriry,an individual shall be informed whether 6e is the subject of soored data on individuals,az�d whether it is classi5ed as pubGc,priv�te or confideatial. Upon his further nquest,an individual who is the subject of stored private or public dara on individuals shall be shown the data without any charge W him and, if he desires, shall be informed of the content and meaning of that data. After an individual has been shown the private data and informed of iu meaning,the data need not be discloud to him for sia mon[hs thec�eafter unless a dispute or action pursuant ro this secaon is pending or addidonal data on the iadividual has been collected or created. T6e responsible suthoriry shall provide copies of the private or public data upon nequest by the individual subject of the data. The responsible authoriry may roquin the requesting person to pay the acwal costs of making,certifying,atnd compiling the wpies. 'Ibe responsble authority sdall comply immediately,if possible,with any request made pursuant to d�is subdivision,or within five days of the date of du cequest,excluding Satu�days,Sl�ndays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so infocm the i�iividuat,and may have an addidonal five days within which to comply with the request, excluding Saturdays, Sundays and legal holidays. Subd•4. Procedure when data b not ace�u�ate or�. An individual may contest the accuncy or compleuness of public or private data conceming himself. To ezercise this right,an i�ividual shall notify in writing the respons3le suthority describing the nature of the disagreement. The �espoosible authority shall within 30 days eidier. (a)cocrect the data found to be inaccurate or inwmplete and attempt to nodfy past rocipients of inaccurnte or incomplete data,including recipients named by the individual;or(b)nodfy the individual d�at he believes the data W be cortect. Data in dispute shall be disclosed only if the individual's statement of disagreement is induded with the disclosed data. 'lt�e derecmination of the cesEwnsble authoriry may be appealed punuaot ao the pmvisions of the administradve procedure act relating w contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would lilce 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: " � I1. The information you fumish 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 shazed with other local, state or federal agencies to the extent necessary to process the pemut or license. 4. If your requested permit or license requires Council acdon 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. ��d f�.� S. ��/��smn F�rst Middle Last ��, sa�� 7_�� Address � o%..�n2��t.r �YJ�/ 6�u'�/�7 �o/Z .�5�3 Z 7 Z- � C��Y State Zip Phone I understand m ' ts as s above. � Signatu 10