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, • , Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd.l. Type of data. The rights of Individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Informatton required to be given individual. An individusl asked to suppty private or contidential data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,polittcal subdlvision,or statewide system;(b) whether he may refuse or fs legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or conRdential data;and(d)the identity of other persons or entities authorized by state or federa!Iaw to receive the data. This requirement shall not apply when sn individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a Iaw enforcement otticer. The commissio�er of revenue mav place the notice reauired under this subdivision in the Individual income t$x or orooertv tax refund instructions tnstead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible suthority,an individual shall be informed whether he is the subjeM of stored data on individuals,and whether[t is classified as public,private or confidential. Upon his further request,an individusl who is the subject of stored private or public data on[ndividuals shall be shown the data without 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 tnformed of Its meaning,the data need not be disclosed to him for six months theresfter unless a dispute or action pursuant to this section is pending or additional data on the Individual has been rnllected ar created. The responsible aut6orlty shall provide copies of the private or public data upon request by the individuai subject of the data. The responsible authority may require the requesting person to pay the actual costs of maWng,certitying,and compiling the copies. The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date otthe request,excluding Saturdays,Sundays and legai holldays,if immediate compliance is not possible.If he cannot rnmply with the request withtn that time,he shall so inform the indivldual,and may have an additional five days within which to comply with the request,excluding Saturdays,Sundays and legal holidays. Subd.4. Procedure when data is�ot accurate or complete. An individual may contest the accurscy or completeness of public or private data concerning h[mse1L To exerctse this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement.The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or(nrnmplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be rnrrect. Data in dispute shall be disclosed only if the indlv(dual's statement of disagrecment is included with the disclosed data. The determination of the responsibte authority may be appealed pursuant to the provisions of the administrative 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 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 permit 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. � �ss�� r ��;�� , ��a►,��1 First Middle Lsst �,SGIQS C- z ¢'S' ;p� N • Address f-�-,o �, �l i�• �y�f �1�,3 , �s -3�a Ctty State Zip Phone I unders nd my rights a ed above. i � � � , ��T �---,� Signatu