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( � r ' Sec.13.04 RIGIiTS OF SiJBdECTS 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 secdon. S�bd.2. Informatlon req�rired to be given individual. An udividual asked w supply private or confidential data concerning himself shall be informed of: (a)the pucpose a�l inte�ed use of the requested data within the collecting state agency,political subdivuion,or statewide system;(b)whether he may refuse or is legaUy required W supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidential data;and(d)the idendty of other persons or entides authorized by state or federal law to receive the data. This requiremeat shall not apply when an individual is asked to.supply inyestigadve data, pursuant to section 13.82, subdivision 5,to a law enforcement officer. The co�missioner of revernte mav olace the noace reauired under this subdivision in the individual income taz or urocertv tax refund instrucdons instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or confidential. Upon lus further request,an individual who is the subject of stored private or pvblic data on individuals shall be shown the data without any charge to him and,if he desires,shall be informed of the conunt and meaning of that daha. After an individual has been shown the private data and informed of iu meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this section is pending or addidonal data on the iadividual has been collected or created. The rosponsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual cosu of making,certifying,and compiling the copies. The responsible authoriry shall wmply immediately,if possible,with any request made pursuant to dus subdivision,or within five days of the date of the request,ezcluding Sadudays,Suixlays and legal holidays,if immediate compliance is not possible. If he cannot comply widi the request within that time,he shall so inform the i�ividual,and may have an addiaonal five days within which to comply with the request, excluding Saturdays,Su�lays and legal holidays. S�bd.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 ezercise this right,an individual shall notify in writing the responsible suthority describing the nature of the disagreement. The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete a�attempt to noafy past recipients of inaccurate or i�omplete data,i�cluding recipients named by the i�ividual;or(b)notify the individual that he believes the dara W 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 authoriry may be appealed pursuant W the provisions of the administrative procedure act relating w 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�ity of Orono or any of its departments may require you to furnish certain private or confidential information. You aze 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 supp�y data, but refusal�nay 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. l Sb C�v�1 /.v A:��.. G A.�c'c�4-�) First Middle I-ast �� l��G L�� 1Y I Address o R.��-, �1,v s:j'3S� �y�-�r� 8� C��y State Zip Phone I unders my rights as st above. , Si ture � 6