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� � ,. , � � Sec.13.04 RIGHT9 OF SUBdECTS OF DATA Subd.1. Type of data. The rights of individual aa whom the data is strned or to be storod shall be as set forth in this secdan. Subd.2.Information requiied to be given individnaL An mdividnal asked to suPP13'P�'ri'ate or coafidential data conceming himself shall be infarmed of: (a)tho piupose aad intended use of the requested dam withm the coliectiug state agency,Political subdivision,a�r statewide system;(b) whether he may refuse or is legally requ'ved to supply the requested data;(c)any]mown conseqirence arising from his supplyiag or n�usiag to supply private or conSdential data;and(d)ffie idendty ofother persons or entities anthoriad by state or fede►al law to xeceive the data This requiremeat shalt not apply when an indfvidual is acked to yupply,investigaflve data,p�asuant to section 13.82,subdivision 5,to a law enforcement officer. The cwnmissi�er of reveneP„��!�P the notice reg�tired under this subdivision in the individual'nrAme tax a2 W�A�Y tax refimd inctn.rtio�ut�9a of on i1+os.f Subd.3.Access to data by iadividuaL Upon�quest to a responsible authariry,an individual shall be mformed�yhetha he is die subject of starod data on individuals,aad whether it is classified as pubGc,private or confidentiaL Upon his fiuiherreyuest,an individual who is the subject of stared privau or public data on iadividvals shell be shown the data without any charge to hvn aad,if he desiros,shall be informed of the content and meaning of that data After an individual has been shown the private data aad informed of its meaning,the data nad not be disclosed to him for six months thereafter unless a dispute or action puisuaat to this secdon is pending or additional data on the individual hac becn wllected or cieated.The responsible authority shall pmvide copies of the private or public data upon request by the individual subjcct of the data. The nsponsible authority may require the requesting peison to pay the acWal costs af maldng,certifying,and 1' the ies. �� P 1'he iesponsible authority shall comply i�ediately,ifpossble,with any request mado pmsuant ta this subdivisian,or within Sve days of the date of the iequest,excluding Saturdays,Sundays a�legal holidays,if immediate compGan¢o is not possible.ffhe caffiot comply with�e request within tt�at time,he shall so inform the mdividual,and may 1�ave an additional frve days within which to co�ty with the roquest,exchiding Sahuxiays, Sundays and legal hotidays. Subd.4.Procedine when data is not aa,wate or co�lete.An individval may contest the acc�nacy as comq�leteaess of�ublic orprivate data concerning himse(f.To exccise this right,an individual shall notify m writing flx nespon�ble authority descn'bing the napme of tbe disagtecnent.The ne�onsible authority shall within 30 days either: (a)correct the data found W be inaccmate or incompkte end attempt W notify past recipieats of inaccmate or inco�kte data,mcluding recipients nemed by the individual;or(b)notify the individuel that he believes the data to be cornecG Ihta m dispute shall be disclosed onty if the individual's statement of disegreement is included with the disclosed data. 'The determiaadon of the r�spoasible authority mey be appealed pursueat to the provisions of the admiaistrative procedure ect relaring to conbested cases. DATA PR�VACY�DVISORY In accordance with M.S.13.04,Subd.2,"Rights of subj�ts of data",we would like to inform you that your request for a pernut or license from the City of Orono or any of its deparirnents may require you to fumish certain private or confidenrial informarion. You are notified d�at: 1. The information you furnish will be used to detennine your quaiificatian far the permit or license requested. Z• 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 extex►t necessary to process the permit or license. 4. If your requested permit or license requires Council action to appmve,some information may become public. 5. You have certain rights under M.S. 13.04(available upon request)tfl review private data on yourself. 6. Your full name is required to process this application ar pennit. t�l Y1n I I l �c-�� l o r�, r.� �'LS�rI'}1 Y1 qS `-T-i.� � r� ��QS � t :vt� r 2S S�� Flrat I.ast �� ` 1 C'Lt,YI�`�Q� K n��c'� Addresa �—�� I ��{ 5 I ��c�� Clty 3tate ZiP Phone I understand my rights as stated above. Siguatun 32