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� Sec.13.04 RIGHTS OF SIJB.TECTS OF D.�.Ta Subd. 1. Type of data. "Ihe ri¢hcs of individual on whom che data is stored or to be stored shall be as sec forth in this secdon. Subd.2. Information reqtrired to be given individual. P.n individual asked to supply private or confidenrial data conceming himself shall be informed of: (a) che purpose aad incended use of the requesced dara within the colleccing'state agency, poliacal subdivisiou,or sratewide rystem; (b)whether he may refuse oY is legally required to supply the requested data;(c)any k�own coasequence arising from his supptying or refusing to supply • privare or confidendal data;and(d)che idendry of other peaoos or enriries au[horized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesrieaave dara, pursuant co secoon 13.82, subdivision 5, to a law enforcemenc o�cer. - The commissioner of re�•enue mav place the noace reauired under this subdivision in the individual income tax or propertv tax refund instrucdons instead of on chose forms. Subd. 3. Access to data by indi�idual. Upon requesc to a responsible authoriry,an individual shall be informed whether he is the subject of scored data on individuals, and whecher it is classified as public, privace or confidenaal. Upon his further request, an individual who is the subjecc of stored private or public data on individuals shall be shown the data wi�hout any charge to him and, if he desires, shall be informed of the contenc and meaning of chat data. Afrer an individual has been shown the privace data and informed of ics meaning, the data need not be disclosed to him for six mon[hs thereafter unless a dispute or acdon pursuant to this secaon 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 responsib(e autfioriry may require the requesring person to pay the accual costs of making, certifying,and compiling[he copies. The responsible authoriry shall comply immediacely, if possible, with any request made pursuant to chis subdivision, or wirhin five days of the date of the requesc,excluding Sacurdays,Sundays and legal holidays,if immediace compliance is noc possible. If he cannot comply with the request within that time,he shail so inform rhe individual,and may have an addirional five days wi[hin which to comply wich the cequesc,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 private data concerning himself. To exercise�his rieht,an individual shall noafy in writing the responsible auchoriry describing the nacure of the disagreemenc. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplece and attempe to noafy past recipienrs of inaccurate or incomplete data, inc(uding recipiencs named by the individual;or(b)notify the individual that he be(ieves the data to be coaect. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The de[erminadon of the responsible authoriry may be appealed pursuan[to the provisions of the admuustrarive procedure ac[relacin� to contesced cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Ri�hts of subjects of data", we would like[o inform you tha[your request for a permit or license from the Ciry of Orono or any of i[s 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 pemut or license. 3. The information may be shared with other local, state or federal agencies to the ex�ent necessary to process the permit or license. 4. If your requested permi[ or license requires Council action to approve, some information may become public. 5. You have certain ri�hts 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. v1rA��✓�� J S w.r��S�>-� First Middle Last 33v�) ;vM.ArZ�Zu L� Addcess ,iy�� 1.,d, dv�.� Ss 3`f( �G�L� `!7I-o�'�� Ciry State Zip Phone I underst � ��hts as stated above. �` ��'�" �,.,✓.�-�..,.-----�-� Signature