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1 i> ^� ., Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Information required to he gtven individual. An individual asked to supply private or confidential data conceming himself shall be iaformed of: (a)the purpose and intended use of the requested data within 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 known consequence arising from his supplying or refusing to supply priva�e or confidential.data;and(d)the ideniity of other peisons or entities authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 9,to a law enforcement officer. The com,,,;ccinner of ievemie mav nlace the notice reauiced u�er this sibdivision m the individual income tax or orovertv tax refund insuuctions instead of on those forms. Subd.3. Access to daffi by mdividual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on�ividusls,and whdher it is classiSed as public,private or confidential. Upon his further request,an individual who is the subject of stored priva�or public data on individuals shall be shown the data without any charge to him a�,if he desires,shall be informed of ihe content and meaning of that data. After an individual has been shown the private data and informed of iu meaning,the data need not be disclosed to him for six mon�s thereafter unless a dispuL�or action pursuant w this section is pending or additional data on the individual has been collected or created. The responsible aud�ority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual costs of making,ceitifying,and compiling the copies. The cesponsible authority shall comply immediately,if possible,widi any request made pursuant w dvs subdivision,or within five days of the date of the iequest,excluding Satuidays,Sundays a�legal holidays,if immediate compliance is not possible. If he cannot comply with die request within that fime,he shall so inform the individual,and may have an additional five days within which to comply with the request,excluding Saturdays,Sundays aud legal holidays. �. �bd.4. Pracedure when data i�not acc�uate or complde. An individual may contest the accuracy ar completeness of public or private data com;emiag h�self. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement. The cesponsible amhority shall withm 30 days either. (a)corc�t the data found to be inaccurnte or incomplete and attempt to notify past recipient�of inaccutate or incomplete da4,mclud'mg recipients named by the individual;or(b)notify die individual that he believes 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. The determmation of the responsible autlwrity may be appealed pu�suant to the provisions of the admiaistrstive procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, S�bd. 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 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. /1�'�c,� �c�� .�G�'�.�'-l•r/G �First Middle L.ast C`S�{SR �c�sZ yo N �.`z��e Address �� i�,-i-;�. yj,�•✓ S��f� �s�-��'�`Solo City Sate Zip Phone I understand my rights as stated above. '� C�/��G�.r/�Gr Signature 10