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.� ..r� � _ � Sec.13.04 RIGHTS OF SCTB.JECTS OF DATA Subd. 1. Type of data. The rights of individual on whom[he data is stored or to be stored shall be as set focth in this section. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal daca concerning himself shall be informed of: (a)the purpose and inunded use of the requested data within the collecang§tace agency,polidcal subdivision,or statewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any la�own consequence arising from his supplying or refusing to supply privace or confidendal data;and(d)the idendry of other penons or enddes aurhorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesrigadve daca,pursuant to secdon 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of revenue mav alace the nodce rewired under this subdivision in the individual income tax or Qropertv tax refund insnvcrions inscead of on those forms. Subd.3. Access to data by individuai. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whe[her ic is classified as public, private or confidendal. Upon his further request,an individual who is the subject of stored private or public dara on individuals shall be shown the da[a wi[hout any charge to him and,-if he desires,shall be informed of the content and meaning of that data. After an individuai has been shown the priva[e data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acdon pursuant to tivs secaon is pending or addidonal data on the individuai 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 authority may requiro the requesring person to pay the actual costs of making,cerdfying,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 Samrdays,Sundays and legal holidays,if immediace compliance is not possible. If he cannoc comply with the request within that time,he shatl so inform[he 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 public or private data conceming himself. To exercise chis right,an individual shall norify in wricing rhe responsible authority describing the nacure of the disagreement. The responsible authoriry shal(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 recipiencs named by[he individual;or(b)notify the individual that he believes[he 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 responsibte authority may be appealed pursuant to the provisions of the adminisaadve 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 furnish certain private or confidential information. You are notified that: 1. The information you fumish will be used to detemune 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 shazed with other local, state or federal agencies to the extent necessary to process the pemut 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. r .2� % rD �e.�� ` � �tna e�� Fint Middl � Last �70U f�n/la D��`� ,��-� Su� � /�--1� - Address �� ��ti�/�r 5"�� L�' /l� SS�f`/`7 s�5 3-0o LS"� . City T � Sm� Zip Phone I understand my rights as stated above. �._. � Signamre