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i , . _, _ � Sec.13.04 RIGHTS OF SiJBJECTS OF DATA � Subd. 1. Type of data. The righu of individual on who the data is stored or to be stored shall be as set forth in this section. S�bd.2. Information required to be glven individual. individual asked to supply private or confidential data conceming himself shall be informed of: (a)the purpose and intended use of the requeste data within the collecting state agency,political subdivision,or statewide system;(b)whether he may refuse or is legally required to supply th requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidential data;and(d)the identiry of o r persons or entiaes authorized by stau or federal law to receive the data. This requirement shail not apply when an individual is asked to su ply investigadve data,pursuant to section 13.82,subdivision 5, to a law enforcement officer. e ' er f ve la e re 'v' ' i 'v' in r instructions instead of on those forms. Subd.3. Access to data by indtvidual. Upon request a responsible authority,an individual shall be informed whether he is the subject of swred data on individuals,and whether it is class�ed as blic,private or confidential. Upon his further request,an individual who is the subject of stored private or�blic data on i�ividuals shall be sh wn the data without any charge ro him and,if he desires,shall be informed of the content ancl meaning of that data. After an individual has bee shown the private data and informed of its meaning,the data need not be disclosed ro tvm for siz mondu thereafter unless a dispute or acfion pu to this section is pending or additional data on the individual has been collected or created. 'Ihe responsible authority shall provide copies of e private or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay e actual costs of maldng,certifying,and compiling the copies. The responsible authority shall comply immediately,if po ble,with any request made pursuant to dris subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legai h lidays,if"vnmediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and y have an addirional five days within which to comply with the request, ezcluding Saturdays,Sundays and legal holidays. � Subd.4. Prceedure when data is not accurate or com ete. An individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual hall notify in wridng the responsible authority describing the nature of the disagreement. The responsible authoriry shall within 30 days either: ()cornct the data fwmd ro be inaccurate or i�omplete and attempt to notify past recipients of inaccurau or incomplete data,including recipienu ed by the imlividual;or(b)norify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individu 's sratement of disagreement is included with the disclosed data. The denem�inadon of the responsible authority may be ap ed pursuant W the provisions of the administradve procedure act relating to contested cases. DATA PR In accordance with M.S. 13.04, Subd. 2, "Right of subjects of data", we would like to inform you that your request for a permit or license from the Giry of Orono r any of its departments may require you to fumish certain private or confidential information. j You aze notified that: i I 1. The information you furnish will be us�d to determine your qualification for the permit or license requested. 2. You may refuse to supply data,but re al may require that the City deny the permit or license. 3. The information may be shazed with o er local, state or federal agencies to the eztent necessary to process the pemut or license. 4. If your requested pemut or license requ' s Council action to approve, some information may become public. 5. You have certain rights under M.S. 13. (available upon request)to review private data on yourself. 6. Your full name is required to process s aPplication or pe t. /l��NSo�J 2 �c1 T�1G�0�2 L�ES i��, �i1�� "D v �a �ohl First Middle Last /2./� g , UiTG- Z� z. Addross Q L-1� S /�/Z-'�3 S'a� Ci State Zip Phone I understand y rights stat d above. `�,V s��n� � 6 � i I �