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� Sec.13.04 RIGHTS OF SUB.TECTS 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 forrh in this secdon. Subd.2. Information required to be given individual. An individual asked to supply private or confidenaal data conceming himself shall be informed of: (a)[he purpose and intended use of the requested data wi�hin the coliecting'state agency, polidcal subdivision,or stacewide system; (b)whether he may refuse or is legally required to supply the reques[ed data;(c)any Imown consequence arising from his supplying or refusing to supply private or confidenoal data;and(d)the idendry of other persons or enades authorized by state or fedecai law to receive the data. This requirement shall not apply when an individual is asked to supply invesagadve data, pursuant to secrion 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of revenue mav place the norice required under rhis subdivision in the individual income tax or prooertv tax refund instrucrions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whethec he is the subject of stored data on individuals, and whether it is classified as public, priva�e or co�dential. Upon his funher request, an individual who is the subject of stored private or pubiic data on individuals shall be shown the data wirhout 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 irs meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this secaon is pending or addirional data on the individual has been collected or creaced. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the actual costs of making, cerafying, and compiling the copies. The responsible au[horiry shall compty immediately, if possible, with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays, if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addiaonal five days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure�vhen data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. The responsible authoriry shail within 30 days either. (a)correct the data found ro be inaccurate or incomplete and attempt to nodfy past recipienu of inaccurate or incomplete data, inciuding recipienu named by the individual; or(b)nodfy the individual thac he believes the data to be correcc Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. Tne determination of the responsibie authoriry may be appealed pursuan[to the provisions of the administrative procedure act relating to 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 City of Orono or any of its departments may require you to furnish certain private or confidential information. You are notified that: i. The information you furnish will be used to determine your qualification for the pemut or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the pernut or license. 3. The information may be shared with other local, state or federal agencies to the extent necessary to process the pernut 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. (, Your full name is required to process this application or permit. i ,,�-��—if t��c� ��st-�7f First �tiddle Las[ �-s �� U ��f1�.� i��s� Address �i- z�� �-1 n.' SS '_�`7 t/ % >> - L Z"Z 1 C�� State Zip Phone I understand my,sights as stated above. ��_ ��-\ �� ,�; _ Signature