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, � Sec.13.04 RIGH'TS OF S[JB.TECTS 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. Subd.2. Information required to be given individual. An individual azked to supply private or confidendal dara concerning hunself shall be infonned of: (a)the purpose and intended use of the requested data within the collecring state agency,political subdivision, or statewide system; (b) whether he may refuse or is legally required to suppiy the requested dara;(c)any known consequence arising from his supplying or refusing to supply private or confidential data; and(d)the idendry of other persons or enudes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigarive data, pursuant to section 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav Place the nodce ie4uimd under this subdivision in the individual income tax or propertv tax refund instrucrions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authoriry, an individual shall be informed whether he is the subject of stored data on individuals,and whether it u classified as public,private or confidenaal. i;pon his further request, an individual who is the subject of stored privare or public data on individuals shall be shown the data without any charge to him and, if he desires, shall be inforcned of the content and meaning of that data. Afrer an individual has been shown the private data and informed of its meaning, the data need not be disclosed to him for six months d�ereafrer unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible audioriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesdng person to pay the actual costs of making,certifying,and compiling the copies. The responsible authority 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 unmediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform 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 is not accurate or complete. An mdividual may contest the accuracy or completeness of public or private data conceming himself. To exercise this right, an individual shall nodfy in writing the responsible authority describing the nature of the disagreement. The cesponsible aurhority shall within 30 days eirher. (a)correct the daa found to be inaccurare or incomplete and attempt to norify past recipienu of inaccurate or incomplete data,including recipienu 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 disctosed data. The detem�inabon of the cesponsible authoriry may be appealed puauant m the provisions of the administrative procedure act relating to contested cases. DATA PRIVACY AD�TSORY 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 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 information may be shared 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 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. �c+�r�..t � �.w.,�h--, First � Mid�d]le � 9 Lanst �� / _S�Z�j,�� �ZT7 '��Sr �K ( �l J:JY 4��J� �l/l S ' " ��l/ J 1 Address � ,4 "- � Lal7 .�� 3 Z"i�G ��y T State Zip Phone nderstand my rights as stated above. � � _. _...>-� ,_._ �._� ,.:.::.�_�. Signature ` 10