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. � Sec.13.04 RIGHTS OF SUBJECTS OF D.aT,� ,. Subd. 1. Type of data. The righ�s of individual on whom the data is stored or to be scored shall be as set forth in this secdon. Subd.2. Informatioo reqirired to be given individual. An individual asked to supply privace or confidendal data concerning himself shall be informed of: (a)the purpose and inrended use of the requested dara wi[hin the collecting'state agency, political subdivision,or sratewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any known coasequence arising from his supplying or refusing to supply priva�e or confidential data;and(d)the identity of o�her persons or enrides auchorized by state or federal law to receive the dara. This requiremeot shall not apply when an individual is asked to supply invesdeaave dara, pursuant to secrion 13.82, subdivision S, to a law enforcement officer. The commissioner of re�•enue mav place the noace r�auired under this subdivision in the individual income tax or propertv tax refund instructions instead of on thnse forms. Subd. 3. Access to data by individual. Upon request to a responsibfe authority,an individual shall be informed whether he is the subject of stored data on individuals, and whe[her it is classiFied as public, private or confidenrial. Upon his further request, an individual who is the subjecc of stored private or public data on individuals shall be shown[i�e data wi[hout any charge to hun and, if he desires, shall be informed of the content and meaning of[hat data. Afrer an individual has been shown[he private data and informed of its meaning,the data need not be disclosed to him for six months[hereafter unless a dispute or acrion pursuant to this secrion is oending or addidonal data on the individual has been collected or created. The responsibie 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 actual costs of makine, certifying, and compiling the copies. The responsible authoriry shall comply immediate(y, 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. If he cannot comply with the request within that time,he shall so inform the individual,and may have an additional 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 concerning himself. To exercise[his rieht,an individual shail norify in wricing the responsible authority dzscribing[he narure of the disagreement. The responsible authoriry shalt within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individual that he be(ieves the dara to be correc[. Data in dispute shall be disclosed only if the individual's sta[emen[of disagreement is included with [he disclosed data. The de[ermination of the responsible au[horiry may bz appealed pursuant to the provisions of the administrarive procedure act relaring to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "Riahts 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: i. 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 pemut or license. 3. The information may be shared with ocher local, state or federal agencies to the extent necessary to process the pernut 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 fuli name is required to process this application or permit. ,,� �yz'v1�� r��`1'Y'c�.C�lC:� �"� First �tiddle Last �j��f� I��✓ �-�' A�� l��i� S �Srk 5�y �l5�_y,� -�%-�,'1 �'7 j� �. � City State Zip Phone I understand y rights as tated above �� s�_ Signature �