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� f Sec.13.04 RIGHTS OF SIIBJECTS OF DATA Subd. 1. Type of data. The righrs of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information required to be given individual. An individual asked to supply private or confidenrial data concerning himself shali be informed of: (a)the purpose and intended use of the requested data within the collecdng'state agency, polidcal subdivision, or statewide system; (b)whether he may refuse or is leeally required to supply the requested data;(c)any l�own consequence arising from his supplying or refusing to supply private or confidencial data;and(d)the idenary of other penons or entiaes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesrigarive data, pursuant to secrion 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of revenue mav place the no[ice required under this subdivision in the individual income tax or propem tax refund instrucrions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shali be informed whether he is the subject of stored data on individuals, and whecher it is classified as public, private or confidenaal. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data without any charge to him and, if he desires, shall be informed of the content and meaning of that data. Afrer an individual has bee�shown the private data and informed of its meaning,[he data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this secdon is pending or addidonal data on the individuai has been collected or creaced. The responsible authority shall provide copies of the private or pub(ic data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the actual costs of making, cerrifying, and compiling the copies. The responsible authority shall compiy immediately, if possible, wi[h 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 not possible. If he cannot eomply with the requesc within that tune,he shall so inform the individual,and may have an addidonai five days within which to comply with the request,excluding Sarurdays, Sundays and legal hotidays. Subd.4. Procedure�vhen data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himse(f. To exercise this right,an individual shall no[ify 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 inaccurate or incomplete and attempt to nodfy past recipients of inaccurate or incomplete data, including recipients named by the individua(; or(b)notify the individual that he belizves the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. Tne determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating 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 pernut 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 deternune your qualification for the permit or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the pernut or license. 3. The information may be shared with other local, state or federal a?encies 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. 1�4 �'L. �f G�6.�=�� kt�,�C-� First viiddle Last 5`�C�I �--L�we��—(,�� . Address !l' . � �' C- _C � i�,�r,,� l S , 11,�t r..� �.�`I 1 � ( 2 i -�S�� Cin, State Zip Phone I understand my rights as tated above. _ �� 5ignature