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Sec.13.04 RIGH'I'S OF SUBJECTS OF DaT� Subd. i. Type of data. The righ�s of individual on whom che data is stored or co be stored shall be as set fonh in this secdon. Subd.2. Information required to be given individual. An individual asked to supply private or confidenaal data concerning hunself shall be informed of: (a)the purpose and inttnded use of the requested data within the colleccing'sta[e agency, polidcal subdivision,or sratewide system; (b)whether he may refuse ot is legally required to supply the requested data;(c)any laiown consequence arising from his supplying or refusing to supply priva[e or confidendal data;and(d)the idennty of o[her penons or enrides authorized by state or federai law to receive the data. This requirement shall not apply when an individual is asked to supply invesrieadve dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of re�enue mav place [he nodce reauired under this subdivision in the individual income tax or propectv tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upon requesc to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public, private or confidendal. Upon his further request, an individual who is the subject of stored private or public data on individuals shall be shown che 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[he private data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acrion pursuan[to this secdon is pending or addidonal data on the individuai has been collected or crea[ed. The responsible authority shall provide copies of the private or pubtic data upon request by the individual subject of che data. The responsible authoriry may require the requesting person to pay the actual cosu of makinc,cerrifying, 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,excluding Sa[urdays,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 addirional five days within which to comply with the request,excluding Sarurdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuncy or comple[eness of public or private data concerning himself. To exercise chis right,an individual shall nodfy in wridng the responsible authority describing che nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccutate or incomplete and attempt to norify past recipienu of inaccurate or incomplete data, inciuding recipiencs named by [he individual; or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individuai's statement of disagreement is included with[he disclosed data. Tt�e determinarion of the responsible authoriry may be appealed pursuan[to the provisions of the administrarive procedure act relaring to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "Ri;hts 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 suppiy 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 pernut or license. 4. If your requested pernut or license requires Council action to approve, some information may become public. j, 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. �J\n' Y� 1�C9��v�C Z \\�.�(�C�.�n� First MMiddle Last �p'� �� 1 \ \c�.� �� Addre s 'V�0. \ \ \�V\ ��i l� �-_��1�� o�"� �-� ��c � Ciry State Zip Phone I underst d y rights stated above. Signa re