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�� . i Sec.13.04 RIGHTS OF SLJB.TECTS OF DATA Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be scoced shall be as set forch in this secdon. Subd.2. Information req�rired to be given individual. An individual asked to supply private or confidential data conceming himself shall be informed of: (a)the purpose and in[ended use of the requested data wichin the collecting§tate agency,poflacal subdivision,or statewide system; (b)whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supp(ying or refusing to supply private or confidendal data;and(d)che idendry of other penons or enddes authorized by state or federal law to receive the data. T'his requiremenc shall not apply when an individual is asked to supply invesdgadve data, pursuant to secdon 13.82,subdivision 5, to a law enforeement officer. The commissioner of revenue mav place the noace required under this subdivision in the individual income cax or propertv tax refund instrucaons instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuais,and wherher it is classified as public,privace or confidendal. Upon his fur[her request,an individual who is the subject of storod private or public data on individuals 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 informed of its meaning,the data need not be disclosed w him for six months thereafrer unless a dispute or action pursuant to this secdon is pending or addiaonal data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public dara upon request by the individual subject of the data. The responsible au[horiry may require the requesting person to pay[he acma!cosu of making,cerdfying,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 cequest,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the requesc wi[hin that dme,he shall so inform[he individual,and may have an addidonal five days within 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 private data concerning himsetf. To exercise this right,an individua!shall nodfy in writing the responsible authoriry describing the nature of the disagreemenc. The responsible authoriry shail within 30 days either: (a)correct[he data found to be inaccurate or incomplete and attempt to noafy past recipiencs of inaccurate or incomplete data, including recipiencs named by the individual;or(b)notify the individual that 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 determination of the responsible authoriry may be appealed pursuant to the provisions of the adtninistradve procedure act relaang to 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 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. �. � �,�.- � � p � . Middle Last I � �i � r� �(1�t G�� -� Address � �« ; /,��T► � L �- lv� � s� t �� 3 �' � l C��,�— State Zip Phone I understand my rights as stated above. signamre