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Sec.13.04 RIGHTS OF SLTB.TECTS OF D�TA Subd. 1. Type of data. 'Ihe righ[5 of iadividual on whom the data is stored or to be stored shall be as set forth ia this secdon. Subd.2. Information req�red to be given individual. An individual asked to supply private or confidenoal data concerning himulf chail be informed of: (a)the purpose and intended use of the requested data wirhin the collecting'stace agency,polidcal subdivision,or srarewide symm; (b)whecher he may refuse or is le2ally rEquired to supply the requested data;(c)any l�own consequence arising from his supplying or refusing to supply pnvarE or coruidendal data;and(d)the idendty of ocher persons or enddes authorized by s[ate or fedetal law to receive the dara. This requirement shail no[apply when an individual is asked to supply investigaave dara, pursuant to secdon 13.82, subdivision�, to a law enforcement officer. The commissioner oi revenue mav face [he norice reouired under chis subdivision in the individual income rax or rooem taz refur.d insaucnons inscead ot on those forms. Subd. 3. :�ccess to data by individual. Upon request[o a responsible auchoriry,an individual shall be informed whether he is[he subject ot s[ored dara on individuals, and whe[her i[is classified as public, private or confidenaal. Upon his further request,an individual who is the subject oi stored private or public data on individuals shall be shown the data wichout any charge to him and,'if he desires, shall be informed o[the con[enc and meaning of thac dara. Afcer an individual has been shown the private data and informed of irs meaning,the data need not be disclosed to him for six mon[hs chereafter unless a dispute or action pursuant to this secrion is pending or addiaonal data on the individual has been collected or crea[ed. The responsible auchoriry shall provide copies of[he priva[e or public data upon request by che individual subjec[oT the dara. The responsible authori[y may require the requesting person to pay the actual costs of makine, cerrifying, and compiling the copies. The responsible au[hority shall comply immediately, if possible, with any request made pursuant to this subdivision,or within five days of the date of�he request,excluding Sarurdays,Sundays and legal holidays, if immediate compliance is no[possibfe. If he canno[comply wi[h the requesi within that time,he shall so inform the individual,and may have an addidonal five days within which to comply with[he request,excluding Sa[urdays, Sundays and teeal hotidays. Subd.4. Procedure when data is not accurate or complete. An individual may con[es[the accuracy or compleceness of public or privare da[a concerning himself. To exercise chis right,an individual shall no[ify in wnting the responsible authoriry describing the na[ure of the disagreemen[. The responsible authonry shall within 30 days ei[her. (a)correcc the data found to be inaccurate or incomplece and attempc to nodfy past recipien[s of inaccura�e or incomplete data, including recipients named by the individual; or(b) notify che individua(tha[he believes[he data to be correct. Dara in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. Tne determination of�he responsible auchoary may be appealed pursuant to the provisions of the administraave procedure act relaring co conresced cases. DAT� PRIVACY ADVISORY In accordance wi[h M.S. 13.04, Subd. 2, "Rights of subjects of data", we would lil:e 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 infocma[ion you fumish wili 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 permit or license. 4. If your requested permit or license requires Council action to approve, some information may become public. �, You have certain rights under M.S. 13.04 (available upon request) to review priva[e da[a on yourself. (, Your full name is required to process this application or permit. � /� ��c��S ��='e„ /"1 l��e S�c�i, F�� t�ddle Las[ I��S 1--c�1"ncA �� r�c�� '�' Address 1 v�; 11 c )��r� ��3(�4- �-I 7 Z S�} �', State Z�p Phone Ciry I understand my rights as stated above. \ J 7 i o / �'y��, , Signa[ure