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Sec.13.04 RIGHTS OF SUB.TECTS OF DATA Subd. 1. Type of data. 'Ihe righrs of individual on whom the data is stored or to be stored shall be as set forth in chis section. Subd.2. Information req�rired to be givw individual. M individual asked to supply private or confidenaal data concerning himself shall be informed of: (a)the purpose and intended use of the csquesr�d data within the collecting 31ate agency,poliacal subdivision,or statewide sysum; (b)whether he may refuse oY is legally required to supply the requesud data:(c)anY known consequeuce arising hom his supplying or refusing w supply private or confidential data;and(d)the idendry of o�her penons or enrides authorized by state or fedecal law to receive the data. This requirement shall not apply when an individual is asked to supply invesagadve data,pursuant to secdon 13.82,subdivision 5, to a law enforcement officer. The commissioner of revenue mav place the nodce reouired under this subdivision in the individual income taz or prooertv tax refund inst�uctions instead 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 subject of stored data on individuals,and wherher it is class�ed as public,private or confidendal. Upon his further request,an iadividual who is the subject of stored private or public data on individuals shall be shown ehe dara without any charge to him and,-if he desires,shall be informed of the content and meaning of chat data. Afur an individual has bcen shown che privau data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acdon pursuanc to ehis secdon is pending or addiaonal data on the individual has been coltecud or created. The responsib(e authoriry shalt provide copies of the private or public data upon request by the individual subject of the dara. The responsible authoriry may require the requesdng person to pay the actual costs of making,certifying,and compiling the copies. The responsible authoriry shall compty immediately,if possible, with any request made pursuant to this subdivision,or within five days of the date of the request,exciuding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannoc comply with the request within that time,he shall so inform the individual,and may have an addidonal five days within which to compiy with rhe request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or compiete. An individual may conust the accuracy or completeness of public or private data conceming himself. To exercise[his right,an individual shall notify in writing the responsible authority describing the nature of the disagnemenc The responsible authoriry shall within 30 days either: (a)correcc the data found ro be inaccurate or inwmplete and aaempt to nodfy past recipients of inaccurate or incomplete data, including recipients named by che individual;or(b)nodfy the individuaLthac he believes the data to be correct. Data in dispute shall be disclosed oniy if the individual's stacement of disagreement is included with the disclosed data. The determinadon of the responsible au[horiry may be appealed pursuanc to the provisions of the administraave procedure act retating w contesud 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 Ciry 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 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 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 full name is required to process this application or permit. ��/�?�9�� 2Jr TQ� - Fint Middle Lasc -, // 7 z� /�� 6 Z ,y lil//-�T.�.�7`m w R/ Address � / //Q�y�f�t� �� /C/ �J��S 9Ss Z'�S�p City State Zip Phone I understand my rights as stated above. Signature