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f Sea13.04 RIGFiTS OF SLTBJECTS OF DATA Subd. !. Type o[data. The righcs of individual oa whom the data is stored or w be stoced shall be as set focth in this secdon. Subd.2. Information reqirired to be givw iadiridual. .�n individua!uked to suppty private or confidendal dara concecning himself shall be informed of: (a)che purpose and in[ended use of the requesud data wichin the collecang Stare agency,polidcal subdivisian,or scatewide rysum: (b)wheehec he may refuse oY is legally eequired to supply ehe requesced data;(c)any fmown coasequeace arising from his supplying or refusing to supply private or confidenrial data;and(d)the idenary of oeher persoas or enrides au[horized by snce or federal law co teceive t�e data. This requirement shall not appty when an individual is asked to suppiy invesdgadve daa,pursuant to secdon 13.82,subdivision 5, [o a law enfocsemenc o�cer. The commissioner of revenue mav vlace che nodce rcwired under this subdivision in the individua! income tax or erovem tax cefund instrucdons insuad of on chose forms. Subd. 3. Access to data by individual. Upon requesc to a�espansible authority,an iadividual shall be informed whe�her he is ehe subject of stored dan on individuais,and whe�her it is classified as public,private or confidenaal. Upon his furcher requesc,an individual who is the subjecc of stored privace or public data on individuals shall be shown[he dara wichout any charge to him and;if he desires,shall be informed of the content and meaning of�hac data. After an individual has been shown che private dan and inforaud of irs meaning,the data need not be disclosed to him for six mondu chereafur unless a dispute or acdon pursuanc to this secaon is pending or addidonal dara on che individual has been coilecced or created. 'Ihe respansible auehariry shall provide copies of che private or public data upon request by�he individual subjecc of�he daa. The rosponsible authoriry may require che requesang person w pay the acaal cosu of making,cerdfying,and compiling the copies. The responsible auchoriry shall comply immedia[ely,if possible,with any cequac made purruant to this subdivision,or wichin five days of ehe date of che requesc,excluding Saturdays,Sundays and legal holidays,if immediace compliance is not possible. If he cannot compty with the request wi�hin rhat ame,he shall so inform the individual,and may have an addidooal five days wiehin wtuch to comply wi[h ehe request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest che accuracy or completeness of public or private dara conceming himsetf. To execcise this right,an individual shall noafy in wridng rhe responsible auchoriry describing the naeure of the disagreemen� The cesponsible auchoriry shall within 30 days either: (a)correcc[he data found ro be inaccucate or incomplece and atumpc to nodfy past recipienu of inaccurate or incomple�e data,including recipien[s named by rhe individual;or(b)notify ehe individual thac he believes�he dara to be correct. Data in dispuce shall be disclosed only if the individual's sta[emenc of disagreement is included wich the disdosed dara. The dearminaaon of the responsibte auchoriry may be appealed punuant to the provisions of the adminis�arive 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 departments may require you to furnish certain private or confidencial 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 Ciry deny the permit or license. 3. The information may be shared with ocher local, state or federal agencies to the extent necessary to process the permit or license. 4. If your requested permit or license requires Couacil 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. � v\c� �,J ` c i�.�C' Ficsc �tiddle Lasc s�x�6 A ��,�.h DG� s 0 r. — Address . �.o c,k � c�� /� 5"S J�3 �i 7 7-�S 5—� _ Ciry Sace Zip Phone I understand 'ghts scated above. , : ._..____... Signam�e