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! � Sec.13.04 RIGH'TS OF SCTBdECTS OF DATA Subd. 1. Type o[data. The rights of individual on whom the data is stored or to be sWred shall be as sec forth in this secdon. Subd.2. InformaUon required to be givw individual. An individual asked to supply private or confidenaal data concerning himself shall be informed of: (a)the purpose and inunded use of the requesud data within the collecting state agency,polidcal subdivision,or statewide sysum; (b) whether he may refuse or is legally requued to supply the requested data;(c)any Imown consequence arising from his supplying or refusing to supply priva�or confidentiat data;and(d)the identity of other persons or enaties authorized by state or federal law to receive the data. This requimment shall not apply w6en an individual is asked to svppiy investigative data,pursuant to secdon 13.82,subdivision S, to a law enforcement o�cer. 'I1�e commissiocer of�evea�e mav nlace d�e cbCce tewued under dus subdivision in the individual income taz or nrouem tax refund insaucdons instead of on those fortns. SLbd.3. Access to dab by mdividual. Upon request ro a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classi5ed as public,privace or confidentiai. Upon his further request,an individual who is the subject of storod privaa or public data 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 privau data a�info�med of its meaning, the data need not be disclosed to him for siz months thecr.af�r unless a dispux or action pursuant to this secdon is pe�ing or addidonal data on the individual has been collected or created. 1'he responsible authority shall provide copies of the private or public data upon cequest by the individual subject of the data. The responsible authoriry may roquire[he roquesting person to pay the acmal costs of makiug,cerdfying,and compiling t6e copies. 'Ibe�esponsible authority shall comply immediately, if possible,with any request made pursuant to this subdivision,or within five days of[he daoe of the�equest,excluding Sacudays,Swidays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that dme,he shall so infoan the individual,and may have an additional five days within which to comply with the request,excluding Saturdays,Sundays and legal holidays. Subd.4. Procedure when data i�not accurate or compkte. An individual may contest the accuiacy or completeness of public or private data conceming himself. To exencise this right,an individual shall notify in writing the respoatble suthoriry describing the nature of the disagreement. The nespoasible authority shall within 30 days either. (a)coriat the data fou�to be inaccuiate or incomplete and attempt w no6fy past recipienu of inaccurnte or incomplete dara,including recipients named by the individual;or(b)noafy the it�ividual 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. Tt�e determinaaon of the responsible audwriry emy be appealed pursuant oo du provisions of the administiadve 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 fumish certain private or confidential information. You are notified that: 1. 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 permit or license. 4. '" If your requested permit or license requires Council action to approve, some information may become public. 5. Yo4 ha�e certain rights under M.3, 13.04 (available upon request) to review private data on yourself. 6. Youc`full name is required to process this application or permit. �"^- _f. �,� First Middle Last PD. a� �33� Address /',, �,/ �O�Zs��j Z7Z�O ��1.�Is�lOiJ7'V 1 /il..t/ .�J',��7 Ciry . State Zip Phone I understand ' ts as te ve. /� Signaa 10