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Sec.13.04 RIGH'I'S OF SLJBJECTS OF DaTA Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be stored shall be as set for[h in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidential data concerning himself shall be informed of: (a)the purpose and intended use of the cequested data within the coilecting'statc agency,polidcal subdivision,or sratewide system; (b)wherher he may refuse oY is legally required to supply the requested data:(c)any lrnown consequence arising from his supplying or refusing to supply private or confidential data;and(d)the idenriry of other persons or enades au[horized by state or fede�al law to receive rhe data. This requirement shall not appiy when an individual is asked to suppiy invesdgaave dara,pursuanc to section 13.82, subdivision 5, to a law enforcement ofFicer. The commissioner of re�enue mav place the nodce reauired under this subdivision in the individual income tax or propertv tax refund instructions instead of on�hose forms. Subd. 3. Access to data by individual. Upon requesc to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whe[her it is classified as public, private or confidendal. Upon his further request,an individual who is the subjecc of stored private or public data on individuals shall be shown che 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[he private data and informed of its meaning,the data need not be disc(osed to him for six mon�hs thereafter unless a dispute or acrion pursuanc to rhis secdon is pending or addidonal data on the individual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesring person to pay the actual cosu of making, certifying, and compiling the copies. The responsible authoriry shall comply immediacely, if possible, with any request made pursuant to this subdivision,or within five days of the date of the request,exc(uding Saturdays,Sundays and lega]holidays,if immediate compliance is not possibte. If he cannot comply with the request within that rime,he shall so inform the individual,and may have an addirional five days wirhin 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 pri��ate data concerning himself. To exercise this right,an individual shall nodfy in wriring the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomple[e and attempt to norify past recipiencs of inaccurate or incompiete data, including recipients named by the individual; or(b)notify the individual thac he believes the 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 responsible authoriry may be appealed pursuant to the provisions of the administrative 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 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 pernut 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 perm.it. � � /`�G' -C/�' First �iiddle Last `7.� / � ��/' J�J � ��' D Address �/� �/��J /f j� ��; �r �. /� . S �t�`'/�' �!f✓ , � i�� Ciry � Sta[e Zip Phone I understan rights as stated above. � `, �� a-;� G ��/' Sign ; � /