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�. �. � � Sec.13.04 RIGHTS OF SUBdECTS OF DATA Subd. 1. Type of data. The rights of iadividual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Information req�rired to be given individual. An individual asked to svpply private or confidendal data concerning himself shall be informed of: (a)the puipose a�inunded use of the requesred dara within d►e collecting state agency,political subdivision,or statewide sysum; (b)whether he may refuse oY is legally required to supply the requested data;(c)any lmown consequence azising from his supplying or refusing to supply private or confidential data;and(d)the identiry of other persons or enudes authorized by state or federal law to receive the data. This requirement shall not appty when an individual is asked to supply investigadve data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. The commissioner of rovenue mav olace the nodce rewired under this subdivision in the individuai income cax or proaertv tax refund instrucdons inscead of on those forms. Subd.3. Access to data by individual. Upon requesc to a responsible authority,an individual shall be informed whether 6e is ihe subject of stored data on individuals,and wherher it is class�ed as public,private or confidenaal. Upon his further request,an individual who is the subject of stored private or pubiic 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 dara. Afur an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for s'vc months thereafter unless a dispuu or action pursuant w this section is pending or addidonal data on the individual has been collected or created. The responsible authority s6all provide copies of the privau orpublic data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the acmal cosu of making,cerdfying,and compiling the copies. The responsible suthoriry 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 immediate compliance is not possible. ff he cannot comply with the request within that time,he shall so inform the individual,and may have an addirional five days within which w comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure whea data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data conceming himself. To exercise[his right,an individual shall nodfy in wriang the nsponsible authoriry describing the nature of the disagreement. The tesponsible authoriry shall within 30 days either: (a)correct the data found m be inaccurau or incomplete and aaempt to nodfy past recipienu of inaccurate or incomplete data, including recipients 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 disclosed data. The determinadon of the responsible authority may be appealed pursuant to the provisions of the adminisaative procedure act relating co wntested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04,Subd.2, "Ri,,ahts 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 furnish certain private or confidential information. You are 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 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, 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. , � � � , � ��._ First /� M�ddle Last �fb8 � � rn'�n - .�,�d� — � . �(� � 3� 37 1"L a� ,s �� t�-. �S�5�' Ciry State Z►p Phone I understand my ri ts as stated above. Signaatre