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r- . � � - r Sec.13.04 RIGHTS OF SLIB.TECTS OF D�TA Subd. 1. Type of data. The righcs of individual on whom�he data is stored or to be stored shall be as set forrh in chis secdon. Subd.2. Information reqirired to be given individual. �+a individual asked to suppiy private or coofidenual data conceming himself chall be informed oF. (a) the purpose and intended use of the requested data wi[hin the collecting'state agency, polidcal subdivision,or s�atewide ryscem; (b)whether he may refuse or is legally required ro supply the requestEd data;(c)any�o�consequence arising from his supplying or refusing to supply pcivare or confidendal data;and(d)the identi[y of o[her persons or enddes authorized by stare or federal(aw to receive the data. This requirement shall _. not apply when an individual is asked to supply invesngaave da[a, pursuant to secdon 13.82, subdivision�, to a law enforzement o�cer. The commissioner of revenue mav lace che norice re uired under this subdivisio❑ in the individual income tax or orooem rax refund insavcrions insread of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whecher he is�he subject of stored data on individuals, and whe[her i[is dassified as public, priva[e or conTidendal. Upon his further request, an individual who is[he subject of stored priva[e or public data on individuals shall be shown[he data wi[hout any charge to hirn and,'if he desires, shall be informed of the conten[ and meaning of that data. After an individual has been shown the private daca and informed ot iu meaning, che data need no[be disclosed to him for six mon[hs thereafter unless a dispu[e or action pursuant to [his secnon is pending or additional data on the individual has been collected or crea[ed. The responsible au[horiry shall provide copies oi the privace or public data upon request by che individual subject of[he dara. The responsible au[hori[y may require the requesdng person ro pay the actual cosa of making, cerdfying, and compiling the copies. The responsibfe auchoriry shall comply immediately, if possibie, with any request made pursuant to this subdivision, or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays, if immediate compliance is no[possible. If he canno[comply wi[h[he request wichin that time,he shall so inform the individual,and may have an addidonai five days within which to comply wich the request,excluding Sa[urdays, Sundays and leeal holidays. Subd.�. Procedure when data is not accurate or complete. An individual may con[est the accuracy or complereness of public or priva[e data concerning himself. To ezercise chis right,an individual shall norify in writing the responsible authoriry describing the namre of the disagreemenc. The responsible authoriry shall within 30 days either: (a)coaect[he data found to be inaccurace or incomplece and attempt to nodfy past recipienrs of inaccurace or incomple�e data, including recipients named by the individual; or(b)notify the individual that he believes the data to be correcc. Dara in dispute shall be disclosed only if the individual's statemen[of disagreement is included with[he disclosed data. The determinacion of the responsible au�hority may be appealed pursuant to the provisions of the administraave procedure act relating to contesced 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 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 pemuc or license. 3. The information may be shared with other local, state or federal agencies to the eztent necessary to process the pernut or license. 4. If your requested permit or license requires Council action to approve, some information may become public. �. 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 applica[ion or permit. �, 1 �(!;;�( � ''�'L (.i,�' /�(�'�% i� �: ' - � ' A �tiddle Las� Firsc�, ',r�r, �-; •.,,�,1 :Ji�" �r �/ T l�i/� � � i.T v� ��r �. , .Address � • , j i r' i l % ( �� , /!: , /��% � � ��'�� ' P one City , State Z1P I understan� ��ights as stated abov�`.� � � � � � � i' .''� �t �� / �`tgna � � �