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. � � Sec.13.04 RIGHTS OF SLJBJECTS OF DAT� Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set for[h in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenaal data concerning hicnself shall be informed of: (a)the purpose and intended use of the requested data within the collecting'sta[e agency, polidcal subdivision,or sratewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidenaal data;and(d)the identity of other persons or enaaes au[horized by sta[e or federal law to receive the data. This requirement shall no[apply when an individual is asked to supply investieadve dara, pursuanc to section 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav piace the norice reouired under this subdivision in the individual income tax or propertV tax refund instructions instead of on those forms. Subd. 3. Access to data by indi�zdual. Upon request to a responsible aurhoriry,an individual shall be informed whether he is the subject of stored data on individuals, and whe[her ic is classified as public, privace or confidendal. Upon his further request,an individual who is the subjec[ of stored private or public data on individuals shall be shown[he data wichout any charge to him and, if he desires, shall be infoaned of the content and meaning of rhat data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to hun for six months thereafter unless a dispute or action pursuan[to this secdon is pending or additional data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individuai subject of the data. The responsible authority may require che requesting person to pay the actual cosu of making, certifying, and compiling the copies. The responsible authoriry shall comply immediate(y, if possible, with any request made pursuant to this subdivision, or within five days of the date of the request,excluding Saturdays,Sundays and leeal 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 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 himself. To exercise chis rieht,an individual shall norify in writing the responsible authoriry dzscribing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccunte or incomplete and attempt to norify past recipients of inaccurate or incomplete data, including recipSents named by the individual; or(b)notify the individual that he believes the data ro be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsibte authoriry may be appealed pursuant to the provisions of the adaunistrative procedure act reladng 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 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 pemut 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. (. Your full name is required to process this application or permit. I 2- l�, �� �.�,�2A � First yl�ddle Last S �J 7 S� ��''�'l/�l/:3''.� <'� ��1/1� Add/�re/s�s �� •�-�� ( / � � �� >� � V I � ✓)'�'� _r C�ty State Zip Phone I understand my rijti st ed above. � � Signature