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� . � , ` Sec.13.04 RIGHTS OF SIJB.TECTS OF DATA Subd. 1. Type of data. The righu of individual on whom the dara is stored or to be stomd shall be as set forth in this section. Subd.2. Information reqirired to be�ven individual. An individual asked m suPPlY Private or confidendal data concerning himself shall be informed of: (a)the pucpose and inrended use of the requestcd data within the collecting�tate agency,poGdcal subdivision,or staoewide sysoem: (b)whether 6e may cefuse or is legally required to supply the tsquested data;(c)anY known consequence arising from his suPP1Y�8 or refusing to sapply private or confidenaal daca:and(d)the idendty of other persons or entiaes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesdgadve data,pursuanc co secdon 13.82, subdivision 5, [o a law enforcement officer. The commissioner of revenue mav alace the nodce required under this subdivision in the individual income taz or vrocertv ta�c refund instrucrions instead of on those fortns. Subd.3. Access to data by iadividual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subjecc of stored data on individuais,and whe[her it is class�ed as pubiic,private or confidendal. Upon his further request,an individual who is the subject of swred private or pubiic data on individuals shall be shown the data withouc aay c6arge to him and,'if he desires,shall be informed of the content and meaning of that data. Afur an individual has been shown the private data and informed of ia meaning,the data need not be disclosed to him for six mon[hs thereaf[er unless a dispute or acrion pursuant to this secdon is pending or additional data on the individual has been collected or creared. The responsibie authority shall provide copies of the private or public data upon request by the individuai subject of the data. The responsible aurhoriry may require the requesting person to pay the actual cosu of making,cerdfying, and compiling[he copies. The responsible authoriry shall comply immediately,if possible, with any request made pursuant to tivs 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 ehat time,he shall so inform the individual,and may have an addidooal five days within which to comply with the request,ezcluding Saturdays, Sundays and legal holidays. Subd.4. Procedure whea data is not accurate or complete. An individual may contest the accuracy or completeness of public or privatc data concerning himself. To ezercise this right,an individual shall nodfy in wridag the responsible authority describing the nature of the disagreemenG The cesponsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incompleu and attempt to noafy past recipienu of inaccura[e or incomplete data,including recipients named by the iadividua(;or(b)notify the individual that he believes the data to be correct_ Data in dispute shall be disclosed only if the individual's staument of disagreement is included with the disclosed data. The determinadon of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relating tn contested cases. DATA PRNACY 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 deterniine 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 eztent necessary to process the permit or license. 4. If your requested permit or license requires Council action to approve, some information may become public. g, 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. � Gq I✓l- % ` �20� - First M�ddle �� 3 2� ��R�e �H-� _ Addre s ��2.��`�- /`?�y S s�� %�/�SY City State Zip Phone I understan y rights as stated above Signatu