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r � t . , Sec.13.04 RIGHTS OF SUBJECTS OF DATA . Subd. 1. Type of data. The rights of individoal on whom the data is stored or to be Stored shall be as set forth in this section Subd.2. Tnformation required to be gtven indivldual. An individual acked to supply private or coafidemial data conceraing himself shall be informed of: (a)the purpose and intended use of the requested data widvn the collecting state agency,political subdivision,or statewide system;(b)whether he may refuse or is legally required to supply the requested data;(c)any l�own consequence arising from his supplying or refi'cino to supply priva�or confideirtial data;and(cn the ideWicy of other persons or e�ties authorized by state or federal law to receive the data. This requirement shall not apply when an individual i�asked to supply investigadve data,pursuant to section 13.82, subdivision 5, to a law enforcement officer. 'I'�le f rnvam,o mav nlarP thP nnfira rnmiirxi nn�ier thic cuhdivicion in the 121tI1V1HU3I i11COII18[8R Ot DLODeItV t3R TCt71IIa in.ctr«ctions instead of on those forms. �.3. Access to data by indtvidaal. Upon request to a responsihle authority,an individual shall be informed whe�er he is the subject of stored data on individuals,and whedier it is classified as public,private or confidential. Upon lris fiuther request,an individual who is the subject of stored private or public data on individuals shall be shown the data without any charge ro him and,if he desires,shall be informed of the conte�and meaning of that data. After an individual has been shown die private data and infornned of it�meaning,the data need not he disclased to him for six mond�s thereafoer unless a dispute or aotion pursuant to this section is pend'mg or additional data on the individual has been collected or created. The responsible authority shall provide capies of die priva�or public daia upon request by the individual subject of the data. The respons�le authoritY maY re4uire the requestmg person to pay the actual costs of makin8,certifying,and wmp�ing tr►e copies. The responsible awhority shall wmply immediaoely,if poss�le,with a�request made p�usua�to this sabdivision,or within five days of the date of the request,excluding Sawrdays,Sundays and legal holidays,if immediate compliance is not possffile. If he cannot comply wi� the request within that time,he shall so inform the individual,and may bave an additional five days within which to comply wiUi the request, excluding Saturdays,Sundays and legal holidays. 5abd.4. Pra�ure when data is not accroste or complete. An individual may contest the accuracy or compl�teness of public or private data coacerning himself. To exercise�is right,an individnal shall notify in writing the•responsible authority descn'bing the�ature of the d,��„�* The responsffile audwrity shall wid�m 3D days either. (a)correct d�e data found to be inaccurate or incomplete a�attempt to notify past recipiems of inaccurate or incomple�data,includin�r�ipie��amed by die individuai;or(b)notify the individual that he believes the data to be wrrect. Data in dispute shall be disclosed only if the individual's stateme�of disagreement is included wi�the disclosed data. The determinaflon of the respons�ble autlwrity may be appealed pursua�to�e provisions of the administ:ative 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 germit or license from the�ity 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 io supply data,but refusal may require that the City deny the permit or license. 3. The information may be shared with other lacal, 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. � • Fust Middle Last Address City State Zip Phone I understand my rights as stated almve. signature � 6