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� � ., � Sec.13.04 RIGHTS OF SLJBJECTS OF DATA Subd. 1. Type of data. The righrs of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply privau or con6dendal data conceming hiauelf shail be informed of: (a)the purpose and intended use of che requesred data wi[hin the collecting state agency,polidcal subdivision,or statewide sysum; (b)whether he may refuse oY is legaily required to suppty the requested data;(c)any lmown consequence arising from his supplying or refusing to supply private or confidenrial data;and(d)the ideadry of o[her persoas or endries authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigarive dara,pursuant to section 13.82,subdivision 5,to a law enforcement o�cer. The commissioner of revenue mav place the nodce rewired under this subdivision in the individual income tax or oropertv taz refund instrucaons 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 stored data on individuais,and whe[her it is classified as public,private or co�dential. Upon his further request,an individual who is the subject of stored 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 rhe private data and informed of its meaniag,the dara need not be disclosed to hun for six months therea8er unless a dispute or action pursuanc w this secdon is pending or addidonat data on the individual his beea collected or created. The respoasible authoriry shall provide copies of the private or public data upon request by the individual subject of[he data. Tne responsible authoriry may require the requesdng person to pay the actual cosu of making,certifying,and compiling the copies. The responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of the request,exciuding 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 additional five days within which to comply with the request,excludiag 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 this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. The responsible authority shalt within 30 days either: (a)correct the data found to be inaccutate or incomplete and attempt to nodfy past recipienu of inaccurate or incomplete data, including recipients named by[he individual:or(b)noafy the individual that he believes the data to be corredt. Data in dispute shall be disclosed only if the individual's stacement of disagreement is included with the disclosed data. The determinadon of the responsible auc2►oriry may be appealed pursuant to the provisions of the administrarive 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: 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. (, Your full name is required to process this application or permit. ��_ �-l_ /� � ��./� �.—�:,_.� " First �.� M�d� �t J�l`CO /�T� Ly^ � �/<.�P Address ,�, �-� .S�S3�� 6/�- 37S'��6� Ciry State Zip Phone ��1 .J I un rstan y ' ts as stated above. ��—yO��' ignamre