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� J Sec.13.04 RICHTS OFSUBJECTS OFDATA ' ' SubdivrsTon 1. Type of dat2 The rights of Grdividual on whom the data is stored or to be slored sha!!be as set for�h in this section. Subd.2. Injormation required to be gfven lndivlduaL An rndrvidual asked to supply private or confidentia!data concernrng himself shall be injormed of (aJ the purpose and intended use oJthe requested data within the collecting state agency,political subdivision,or statewide syslem;(bJ whether he may refuse or is lega!!y required to supply the requested data;(c)any knotivn consequexce arlsing from his supplying or refusing to supplyprivate or confrdentiaf data;and(d)the iden�iry of other persoru or entities authorized bystate orfedesal law to receive the data. This�equi�ement shall not apply when an indivtdual is asked to supply imestigative data,pursuant�o section 13.82,subdivision S, to a lmv enforcement o�cen The comrnissioner olrevenue mav nlace the notice reouired under thts subdivision in the individual income tax or nrovertv tax refund . instructrons arstead oton those forms. Subd 3.Access to data by individuaL Upon request eo a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whedher it is classrfred as pub/ic,private or confidential. Upon his furthe�request,an individual who is the subject of stored private or public data on ixdividua/s shall be shown the data wi�hout arry charge to him and,if he destres,sha!!be informed oj � �he content and meaning ojthat data. After an rndividua!has been shmvn the private data and informed oJits meaning,the dara need not be disclosed to him for six months[hereafter unless a dispute or action pursuan�to this sec�ion is pending or additional data on the indivldua!has been co!lected or created The resporrsible authority sha11 provide copies of[he private or public data upon request by[he individua[subject of the dala. The responsible aulhority may require the requesting person to pay!he actual costs of making,cert�ing,and compilfng the copies. The responsible authority shall comply immediately,rfpossible,with any reques�made pursuant to thrs subdivision,or withinJrve days of the date ojthe request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possrble. 1,jhe connot comply with the �equest within[hat time,he sha!!so inform!he individual,and may have an additional five days within tivhich to comply with the request,excluding Saturdays,Sundays and legal holidays. Subd.4.Procedure when data is not accurate or complete An individual may contesllhe accuracy or completeness oJpublrc orprivate data concerning hrmself. To exercise this right, an individua!shal!not�in wrrting Jhe responsible authority descrrbing the nature of the disagreement The responsible authorrty siurll within 30 days either: (a)correc�the data,j'ound to be inaccurate or rncompfete and attempt to not� past recipients of inaccurate or incomplete data,ixcluding recipients rramed by the individual;or(b)not�the individual that he believes the data to be correct. Data in dispute shall be disclosed on/y if the tndividual's statement oJdisagreement is included with the disclosed data. The delermination of the�esponsible authortty may be appealed punruant to 1he p�ovisions of the administrative procedure act relating to contested cases. DATA PRIYACYADVISORY InaccordancewithM.S.13.04,Subd.2,"RrghlsoJsubjectsojdata",tvewouldliketoinformyouthatyourrequeseforapermitorlicense from the Ctty of Orono or any oJits departments may require you lo furnish certain priva�e or confrdential injormaliox. You are notifred that: 1. The injormation you furnish wi!!be used to determine your qualifrcation for the permit or license requested. 2. You may refuse to supply dala,but refusal may require that the City derry the permit or license. 3. The injormatron may be shared with other local,state or federal agencies to the extent necessary to process the permil or license. 4. IJyour requested permit or license requrres Council action to approve,some injormation may become public. S. You have certain rights under M.S. 13.04(see following page)to review private data on yourselJ. 6. Your ful!name is requrred to process this application or permit. PLEASE PRINT �i'.'�'fl �`1'�G�, '�Vli7�lail�u �� u'S� Middle Last � 3�2�� .(� �S�a,- / �- � . . Address _.l�/.� � ��T� /��1/ S'S-�3�'7/ � Slate Zip Phone I understand m rights as stared above. ignatu e r 10