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Sec.13.04 RIGHTS OF SIJBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be swred shall be as set forth in this secdon. Subd.2. InformaUon required to be Qiven individual. An individual asked to supply private or confidendal data concerning himself shall be infom�ed of: (a)the putpose and intended use of the roquested data within the collecting state agency,polidcal subdivision,or statewide sysum; (b) wherher he may refuse or is legally required to supply the requested data;(c)any imown consequence arising from his supplying or refusing to supply private or confidenaal data;and(d)the idendry of other persoas or enddes authorized by state or federal law to receive the data. This requirement shall not apply w6en an individual is asked to supply invesdgadve data,pursuant W secuon 13.82,subdivision S,to a law enforcement officer. 'It�e cortunissioaer of ievenue mav olace the notice iewired under this s�bdivision in the individual income taz or orooertv tax refund insuvctions ' instead of on those forms. S�bd.3. A�to data by indivIdual. Upon request to a responsible suthority,an individual shall be informed whether he is the subject of stnred data on individuals,and whether it is classi5ed as�blic,private or confidential. Upon his furt6er reqnest,an individual who is ihe 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 content and meaning of that data. After an individual has been shown the privau data and informed of it�meaning,the data need not be disclosed to him for six months thereafter unless a dispuoe or ac6on pursuant w dus secdon is pending or addidonal data on the individual has been collecud or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the acwal costs of making,certifying,and compiling the copies. 'Ihe�esponcible authority shall comply immediately,if possible,with aay request made pursuant to dus subdivision,or within five days of the date of the cequest,ezcluding Sadudays,Sl�ndays and legal holidays, if immediate compliance is not possible. If he cannot comply with the requesc wi[hin that dme,he shall so infotm the iadividual,aad may have an additional five days within which w comply with the request, excluding Saturdays.Sundays and legal holidays. Subd.4. Proccdure whea data�not accuiate or complete. An individual may contest the accu�acy or completeness of public or private da[a co�eming himself. To ezercise this right,an individual shall nodfy in writing the responsible authority describing the nature of the disagreement. The cesponsible aathoriry shall within 30 days either. (a)co�rect the data found to be inaccurate or inwmplete and aaempt to notify past recipients of inaccurnte or incomplete dara,including recipients named by the individual;or(b)notify the individual ehat he believes the data to be correct. Data in dispute shall be disclosed only if the individual's sraument of disagreement is included with the disclosed dara. 'Ibe derecminadon of the�esponsible authoriry may be appealed pursuant ro dx pevvisions of the administrative procedun act relating ro 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 Ciry of Orono or any of its departmenu may require you to furnish certain private or confidential information. You are notified that: � 1. The inforcnation 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 t�e 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. - J� s ��e� First Middle Iast �?l, . �,.� �f�� 3 � Address r-/L. �o�. �.v .5.5 � �7 G�2 S��1� Z � Ciry �— State Zip Phone I understand my rights as s te a ove. � Signature 10