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h p Sec.13.04 RIGIiTS OF SLlB.TECTS OF DATa Subd. 1. Type of data. The righcs of individual on whom the data is stored or w be stored shall be as set forch in chis secaon. Subd.2. Information reqirired to be given individual. An individual asked to suppiy private or confidenrial data concerning himself shall be informed of: (a)the purpose and iaunded use of the requesud data wichin che collecting's•tau agency,poliucal subdivision,or statewide system: (b)whether he may refuse oY is legally requiced to supply the rtquested data;(c)any Irnown consequcnce arising from his supplying or refusing ro supply privace oc conndendal dara;and(d)the idenriry of o[her pecsoas or enddes aurhorized by stace or federal law to ceceive the data. 'I'his requirement shall not apply when an individual is asked co supply invesri¢adve daa,punuanc to secdon 13.82, subdivision 5,to a taw enforcement o�cer. The commissioner of re�enue mav pla-�the nodce reauired under this rubdivision in the individual income tax or prooem taz refund instrucuons instead of on chose forms. Subd.3. Access to data b�individual. Upon rtquest to a responsibte authoriry,an individual shall be informed whether he is the subject of s[ored data on individuals,and whe[her it is c[assified as public,private or confidendal. lipon his further request,an individual who is the subjecc of stored privace or public data on individuals shall be shown the dara wichout any charge to him and,'if he desues,shali be informed of the content and meaniag of rhat data. After an individual has bcen shown che private data and infortned of iu meaning,the data need not be disclosed to him for six monrhs thereafter unless a dispute or acdon pursuanc co chis secaon is pending or addidonal data on the individual has been collected or creaced. The responsible authoriry shall provide copies of dia private or public data upon tequest by the individual subject of the dara. The responsible authoriry may require the requesdng person ro pay the acaal cos�s of making,certifying,and compiling the copies. The responsible authoriry shall comply immediacely, if possible,with any request made pursuant to this subdivision,or within five days of the date of che request,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comp(y with[he request wirhin rhac time,he shall so inform che individual,and may have an addiaonal five days wirhin which to comply wich 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 pri�•ate data conceming himself. To exereise chis righG��dividual shall nodfy in writing the responsible authoriry describing che nature of the disagreement. The responsible authoriry shall within 30 days eitt:�r: (a)correct the data found to be inaccurate or incomplece and attempt to nodfy past recipienu of inaccurace or incomplete dan, inciuding recipienc�named by che individual;or(b)nodfy[he individual[hac he believes the daca to be correcc. Data in dispute shail be disclosed only if the individual's stacement of disagreement is inciuded wich[he disclosed data. The decerminadon of the responsible auchoriry may be appealed pursuant to[he provisions of the adminis�arive procedure act relating to wntesred 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 reques[ 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 aze notified that: 1. The information you furnish will be used to detemune 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 permit or license. 4. If your requested permit or license requires Council action to approve, some information may become public. �, You have certain ri�hts under M.S. 13.04 (available upon request) to review private data on yourself. 6, Your full name is required to process this applica[ion or permit. � ti ,1 �f`� ytlddlz Lasc F"�� P c� � '�'133 3 Address �� /V�p�5 �� S'S 1 C�ry Stau Z�p Phone I erstand my ri�hts as st • . Signantre