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. � . Sec.13.04 RIGHTS OF SUBJECTS 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 section. S�bd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himself shall be info�of: (a)the purpose a�l inte�use of the requested data withii►the cotlecting state agency,poli6cal subdivision,or statewide sysoem;(b)whether he may refiue or is legally roquired to supply the requested data;(c)any]mown consequence arising from his svpplying or refusing ro supply private or confidernial data;a�(d)the idendry of other persons or entities authorized by state or federal law to roceive the data. This requirement shall not apply when an individual is asked to supply investigadve data,pursuant ro secdon 13.82, subdivision 5, to a law enforcement o�cer. Tha rnmmiccinnPr nf rrvPnnr mav nlarr thr nnfic,e(�ppj�llI1dCT I$IS SU�1V1S10I1 lIl[}1C Ii1dIVIdU31 ItICOIDC�flJC OL DiODCT�V l&E TCfllild in�tr�ctions'utPad of on chose forms. Subd.3. Access to data by individusl. Upon request to a responsible authority,an individual shall be informed whether he is the �bject of stored data on udividuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data without am+charge W him and,if he desires,shall be informed of the content and meaning of that data. After an individual has been shown the private data and informed of its meaaing,t6e data need not be disclosed ro him for siz months thereafter unless a dispute or acaon pursuant ro this section is pending or addirional data on the individual has been collecoed 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 suthority may require the requesting person w pay the actual cosu of making,certifying,and compiling the copies. The responsible authority shall comply unmediately,if possible,with any request made pn�rsuant to ttus subdivision,or within five days of the date of the roquest,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that ame,he shall so inform the individual,and may have an addidonal five days within which to comply with the request, ezcluding Saturdays,Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or compleuness of public or private data concerning himsdf. To ezercise this right,an individual shall notify in writing the respoacble authority describing the nature of the disagreement. The responsible audwriry shall widun 30 days ei@ur: (a)correct the data fouM ro be inaccurate or i�omptete aad attempt to notify past recipients of imdccurate or incomplete data,i�luding recipients named by the individual;or(b)�tify the individua!that he believes the data to be correct. Data in dispute shap be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of t}�e responsible suthority may be appealed pursuant to the provisions of the admiaistradve procedure act relating W contested cases. I?ATA 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�iry of Orono or any of its departments may require you to furnish certain private or confidential information. You ue 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 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. 5. You have certain rights under M.S. 13.04(available upon request)to review private data on yourself. 6. Your fu11 name is required to process this application or permit. n � ��2r'l�r��+e✓ m C�r I 2. �`f}�l��Y _ Fi�t�8 ` L y�I Ct►'G�, I�11/M�e I.asc �� [� A�x�e�s�U✓ 1Mn s5331 �f71� �� Ciry State Zip Phone I understand my rights as stated above. ^ �. signa 6