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Sec.13.04 RIGHTS OF SIJBJECTS OF DATa Subd. i. Type of data. 'Ihe rights of individuai on whom[he data is stored or to be stored shall be as set for[h in[his secdon. Subd.2. Infocmatioa req�red to be given individual. An individual asked to supply private or confidenaal data concerning himself shall be informed of: (a)rhe purpose and incended use of the requested dara wirhin che collecdng State agency,polidcal svbdivision,or statewide sysum; (b)whether he may refuse or is legally required to supply che requesud data;(c)any Imown consequence arisiag fram lus supplying or refusing m supp(y privace or confidendal data;and(d)[he idendry of other persons or enddes authorized by stace or federal law co receive the data. T'his requirement shall noc appiy when an individual is asked co supply invesdgadve data, pursuanc to secdon 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of revenue mav place the nodce required under this subdivision in the individual income taz or oropertv tax refund instrucrions inscead of on[hose forms. Subd. 3. Access to data by individual. Upon request to a responsib(e authoriry,an individuai shali be infocmed whether he is the subject of stored data on individuals,and wherher it is ciassified as pubtic, priva[e or confidendai. Upon his furrher request,an individua!who is the subjecc of stored private or public dara on individuals shall be shown the data wiehout any charge to him and, if he desires,shall be informed of the contenc and meaning of that da�a. After an individual has been shown�he privace data and informed of ics meaning,the data need noc be disclosed to him for six months chereafter unless a dispucc or acuon pursuanc to chis secaon is pending or addiaonal dara on rhe individual has been collected or cnated. The responsible au[horiry shall provide copies of the private or public dara upon request by the iadividual subject of the data. The responsible authoriry may require the requesdng person to pay the aceua�costs of malcing,cercifying, and compiling the copies. The responsible auchoriry shall comply immediately, if possible,wirh any requesc made pursuant to this subdivision,or within five days of the dace of the requesc,excluding Saairdays.Sundays and legal holidays,if immediate compliance is not possible. If he cannot compty with rhe requesc within that time,h�s�all so inform ehe individuat,and may have an addiaonai 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 rhe accuracy or completeness of public or private data concerning himseif. To exercise rhis right,an individual shall nodfy in wridng rhe responsible authoriry describing the nature of che disagreement. The responsible authoriry shall wichin 30 days either: (a)correct the data found to be inaccura[e or incomplae and atumpt w nodfy past recipients of inaccurete or incomplete data, including reci�ien�s named by the individual;or(b)nodfy the iadividual[hat he believes the dard to be corcect Dara in dispute shall be disclosed ortly if the individuai's statement of disagreement u inciuded wi[h the disclosed daa. Tha decerminarion of the responsibte au[horiry may be appealed pursuan[to [he provisions of the adminisnaave procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04,Subd.2, "Rights of subjects of dafa", we would like to inform you that your request for a permit or license from the Ciry of Orono or any of its departments may require you to furnish certain private or confidential information. You aze 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 shazed with other local, state or federal agencies to the eztent necessary to pmcess the pemut 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. our full name is reguired to process this application or permit. � / fZ�r-� J • � �► First Middle Last C7 � R-�r�-Ls 4,oo� � • Addres�QyLa�r�►, � rv• %S's' 3 � � � I Ciry State Zip Phone .�` I unde d my rights ted above. Signaatre