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�r^ t ' � • Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. S�bd.2. Information req�ared to be given individual. An individual asked to supply private or confidential data concerning himself sUall be informed of: (a)the purpose a�intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b)whether he may refuse or is legally required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply private or confidential data;and(d)the idenriry 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 invesdgative data, pursuant to section 13.82, subdivision 5, to a law enforcement officer. 'I'he f wvamin m�v nlarr rt,P„�e;�p rwrn,;rrri nnriPr rhic c�i}uiivicion in the individual income taz or omcertv tax refitnd � instructions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of sWred data on itdividuals,a�whether it is classified as public,private or confidential. Upon his further request,an individaal who is die subject of stored private or public data on individuals shall be shown the data without any charge to him a�,if he desires,shall be informed of the content a�meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed ro him for siz monthc thereafter unless a dispute or action pursuant ro this section is pending or additioaal data on the individual has been wllected or created. The responsible audwriry shall provide copies of du private or public data upon request by the individual subject of the data. The nsponsible authority may require the requesting person to pay the actual wsts of maldng,certifying,aad compiling the copies. The responsible authority shall comply immediately,if possible,with any request made pursvant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays a�legat holidays,if immediate compliance is not possible. If he cannot comply with the request widvn that time,he shall so inform the individual,and may have an additional five days within which to comply with the request, excluding Saturdays,Sundays and legal holidays. Subd.4. Procedure Qvhen data is not accurate or complete. An individual may contest the accuracy or completeness of public or private da�concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement. 'Ihe responsible authoriry shall within 30 days either: (a)correct the data found ro be inaccunte or incomplete and attempt to notify past recipiems of inaccutate or i�omplebe data,inciuding cecipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data in dis�te shall be disclosed only if tt►e individual's statement of disagreement is included with the disclosed data. The determination of the responsble authoriry may be appealed pursuant to the provisions of the administrative procedure act reladng w 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 Gity of Orono or any of its departments may require you to fumish certain private or confidential informarion. You ue 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 eztent necessary to process the permit or license. 4. If your requested permit or license requires Council action to approve, some informadon 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. • /��-��.,�/1' �7" �.-N % �C� First Middle Last f 5S 0 /Z', /9,�i'r� �� Address �ny,v� /��r ss36� �7/-��O�S Ciry State Zip Phone � I understand my rights as stated above. i��`/. �-�� /O�G� Signature � 6