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. � � � Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendai data conceming himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting'state agency, polidcal subdivision,or sratewide system; (b)whether he may refuse or is legally required to supply tbe requested data;(c)any lrnown coasequence arising from his supplying or refusing to supply � private or confidendal data;and(d)the idenriry of other persons or enrities authorized by state or federal law to receive the data. This requirement shali not apply when an individual is asked ro supply invesriearive dara, pursuanc to secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav ptace the norice reouired under this subdivision in the individual income tax or propertv tax refund instructions instzad of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authority,an individuai shall be informed whether he is the subject of stored data on individuals, and whe�her it is c(assified as public, private or confidential. Upon his further request, an individual who is the subject of stored private or public data on individuals shali be shown rhe data wichout any charge to him and, if he desires, shall be informed of the content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acrion pursuant to this secdon is pending or addidonal data on the individual 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 au[hority may require the requesting person to pay the acrual costs 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 Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the requesc within that time,he shall so inform the individual,and may have an addicional five days within which to comply wi[h the request,excluding Sarurdays, 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 pm•are data conceming himself. To exercise chis right,an individual shall nodfy in wridng the responsible authoriry describing[he nacure of the disagreemen[. The responsible authority shall within 30 days either. (a)correct the data found ro be inaccurate or incomplete and attempt ro notify past recipients of inaccurate or incomplete data, including recipiencs named by [he individual; or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individuai's statement of disagreement is included with the disclosed data. The determinadon of the responsible authority may be appealed pursuant to the provisions of the administra[ive procedure act reladng 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 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 pemut or license. 3. T'he information may be shared with other local, state or federal agencies to the extent necessary to process the pemut or license. 4. If your requested pernut 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��e - � S � ' �J First Middle Last � � � �SC� � � � Address � w�� S 7 7� � .� � City State Zip Phone nderstat4 my r' ts as ted ab ve. � Signa �e