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Sec.13.04 RIGHTS OF S[JBJECTS OF DATA Subd. 1. Type of data. The righ[s of individual on whom the data is stored or to be stored shall be as set forth in this secaon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidential data concerning himself shall be informed of: (a)the pu�pose and intended use of the requested data within the collecting�tate agency,potidcal subdivision,or sratewide sysum; (b)whether he may refuse oY is legally mquired to supply the requested data;(c)any known consequence arising from his supplying or refusing co supply private or confidenaal data;and(d)the idenary of other penoas or enddes auchorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to suppiy invesrigadve dara,punuaac to secdon 13.82,subdivision 5,to a law enforcement o�cer. The commissioner of revenue mav place the nodce reauired under this subdivision in the individual income tax or propertv tax refund instructions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsibie authority,an indi�'idual shall be informed whether he is the subject of stored data on individuals,and whecher it is class�ed as public,private or confidentiat. Upon his further request,an individual who is the subject of stored private or public dara on individuals shall be shown the data wichout 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 iu meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acrion pursuant to[his secrion is pending or addiaonal 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 responsible authoriry may require the requesting person to pay the actual cosa 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,ezcluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he canaot 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,excluding Saturdays, Sundays and legal hotidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himseif. To exenise chis right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipienu of inaccurate or incomplete dara,including recipients named by the individuai;or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's stacement of disagreement is included with[he disclosed dara. The decerminadon of the responsible authoriry may be appealed pursuanc 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 pemut or license from the City of Orono or any of its depaztments may require you to furnish certain private or � confidential information. You are notified that: 1. 1fie information you furnish will be used to detemune 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 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. Sin t� I'Y� , e�L� �� '� First � �� i Middl� , Last ' lar AddressIn /�� ^� ,, (�-i��,__9 p�?/\ ` V/ � U [pOU IE.7 {>C�1�}�(/�� i'1 f ""i/ - C�ry State Zip Phone I understand my rights as stated above. ��` Signature