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. . �'._, � Sec.13.04 RIGHTS OF SLJBJECTS 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 fonh in this secdon. Subd.2. Information reqirired to be given individuai. An individual asked to supply private or confidendal data conceming himself 5ha11 be informed of: (a)the purpose and intended use of the requested data within the collecting�tate agency,polidcal subdivision,or statewide system; (b)whether he may refuse or is legally required to supply the�equested data;(c)any imown consequence arising from his supplying or refusing to supply private or confidencial daca;and(d)che idenriry of other persons or enddes authorized by state or federal law to ieceive the data. This requirement shall not apply when an individuai is asked to supply investigadve daca,pursuant to secdon 13.82,subdivision 5, to a law enforcement officer. The commissioner of revenue mav place the nodce required under this subdivision in the individual income tax or aropertv tax refund ins�ucdons instead of on those forms. Subd.3. Access to data by iwdividual. Upon request to a responsible authority,an individual shall be informed whether he is the subjecc of stored data on individuals,and whecher it is classified as public,private or confidential. Upon his further roquest,an individual who is the subjecc of stored private or public dara on individuals shall be shown[he data wirhout any charge to him and,-if he desires, shall be informed of the contenc and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant[o this secaon is pending or addidooal dara on[he individual has been collected 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 authoriry may require the requesting person to pay the acmal cosu of making,cerdfying, and compiling the copies. The responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or widiin five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the requesc within that time,he shall so inform the individual,and may have an addiaonal 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 individual may contest the accuracy or completeness of public or private data conceming himself. To exercise this right,an individual shatl nodfy in writing the responsible authoriry describing the nature of the disagreement. The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of inaccurate or incomplete data, including recipients named by che individual; or(b)nodfy 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[he responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relating to 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 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 pemut or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the pemut 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. `�'� ��fl ��.,� Fi�� Middle Last �-y9� L��.� �.� �� Address �1�, /_/� ��So �7 / '��S� Ci�� State Zip Phone I underst my rights s ted ove. Signa