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� Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. 'I�e rights of individual on whom the data is stored or to be stored shall be as set forrh in this secdon. Subd.2. Information required to be given individual. An individual asked to supply private or confidential data conceming himself shall be informed of: (a)the pucpose and incended use of the requested data wi[hin the collecting§tate agency,poliacal subdivision,or statewide system; (b)whether he may refuse or is legally roquired to suppiy the�equested data;(c)any Imown consequence azising from his supplying or refusing to suppty priva�e or confidenual data;and(d)rhe identity of other persoas or enddes authorized by state or fedecal law to receive the data. This roquirement shall noc apply when an individual is asked to suppiy invesrigaave dam,pursuant to secdon 13.82,subdivision 5, to a law enforcement o�cer. The commissioner of revenue mav place the noace required under this subdivision in the individual income tax or propem tax refund insaucrions inscead of on those forms. Subd.3. Access to data by individual. Upon request to a responsibie authoriry,an individual shall be informed whether he is the subjecc of stored dara on individuals,and whe[her it is classified as public, priva[e or contidendal. Upon his fur[her request,an individual who is the subject of stored private or public data on individuals shall be shown the data wichout any charge to him and,'if he desires, shal!be informed of the coatenc and meaning of that data. After an individual has been shown che private data and informed of its meaaing,the data need not be disclosed to him for six months thereaftec uniess a dispute or action pursuant to this secdon is pending or addidonal 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 requesang person to pay the actual costs of making,certifying,and compiling the copies. The responsible authoriry shall comply immediately,if possible,with any request made pursuant co this subdivision,or within five days of the date of the request,excluding Samrdays,Sundays and legal holidays,if immediate compliance is noc possible. If he cannot comply with the requesc within that time,he shall so inform the individual,and may have an addidonal five days within which to comply with the roquest,excluding 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 himsetf. To exercise this right,an individual shall norify in writing the responsible authoriry describing the nature of the disagreement. The responsib(e authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of inaccurate or incomplete data, including recipients named by che 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 statemenc of disagreement is included with the disclosed data. The determination of the responsible authority may be appealed pursuant to the pmvisions of the administrarive procedure act relating to contes[ed 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 fumish certain private or confidential information. You are notified that: 1. The information you fumish will be used to determine your qualification for the permit�or license requested. 2. You may refuse to supply data, but refusal may require ihat 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. 6. Your futl name is required to process this application or permit. �� ',� �/��0�2 y ��A�� g�� Middle Last � �oo c��sl,��z� �,� i� Address ,�/ �S-�.��/ �-s� 63 d� ��2.g��s- �r2�v� �i, _ C�h, State Zip Phone I understand 'ght as stated abo f. , Signatu