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� , . Sec.13.04 RIGHTS OF SUB.JECTS OF DATA Subd. 1. Type of data. The righrs of individual on whom the data is stored or co be scored shall be as set forth in this secdon. Subd.2. Information req�red to be given individual. An individual asked to supply private or confidenaal data concerniag himself shall be informed of: (a)the purpose and intended use of the requested data wirhin the collecting'state agency,political subdivision,or stauwide system; (b)w6ether he may refuse o'r is legally requiced to supply the requesud data;(c)any lrnown consequence arising from his supplying or refusing to supply privau or confidendal data;and(d)the idenury of other persons o�enrides authorized by sta[e or federal law m receive the data. This requiremenc shall not appiy when an individual is asked to supply invesdgadve dara,pursuant to section 13.82,subdivision S, to a law enforcement o�cer. The commissioner of revenue mav place the nodce rewired under this subdivision in the individuai income tax or propertv tax refund instrucdons inscead of on those forms. Subd.3. Access to data by iadividual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or confidenaal. Upon his further request,an individuat who is the subject of stored private or public data on individuals shall be shown the data wichout any charge to him and;if he desires,shaU be informed of the content and meaning of rhat data. After an individua!has been shown the private data and informed of ics meaaing,[he data need not be disclosed m him for six months thereafur unless a dispute or acdon pursuant to this secdon is pending or addidonal data on the individual has been collecud or created. The responsible authoriry shail provide copies of the private or public data upon request by the individual subjecc of the dara. The responsible authority may roquire the requesdng person to pay the accual cosu of making,certifying,and compiling the copies. The responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Satutdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform che individual,and may have an addidonal 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 pubiic or private data conceming himself. To exercise this right,an individual shall nodfy in writing the responsible authoricy describing[he narure of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and atumpt to nodfy past recipienu of inaccurate or incomplete data, including recipients named by the individual; or(b)nodfy the individual tha�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 decerminadon of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to wntested 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 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 pertnit 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 (availabie upon request) to review private data on yourself. 6. Your full name is required to process this application or permic. -��L3; /�— te �.� e G� �' 'G�� Fint � ) / ��d�e Last 5 C r �e�_ � '2 Address C /'�/ � /� ��ry gm� Z�p Phone I understand my rights as stated above. r Si amre