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, � Sec.13.04 RIGATS OF SUBJECTS OF DATA Subd. 1. Type of data. The righu of individual on whom the data is stored or ro be stored shall be as set farth in this sectiom Subd.2. Information req�ured to be given ind�vidual. An individual asked to supply private or confidendal data concerning himself shall be informed of: (a)die purpose and intended use of the requested dara within die collecting 3�aate agency,political subdivisian,or statewide rys�m; (b)whedier he may refuse oY is legally required to supply the requested data;(c)aay imown consequence arising from his supplying or refnsing w supply private or confidential data;and(d)the idenury of other persoas or entities aurhorized by state or fedecal law w receive the data. This requirement shall not apply when an individuat is asked to supply invesrigadve data,punvant ro secdon 13.82,subdivision 5,to a law enforcement officer. The commissioner of revemie mav place the nodce rewired under this subdivision in the individual income tax or arooertv ta�c iefand insnuctions instead of on those forms. Subd.3. Access to data by individual. Upon request to a respoasible authority,an individual shall be informed whether he is the subject of stored data on individuals,and wherher it is class�ed as public,private or confidential. Upon his further request,aa 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. After an iadividual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acuon pursuant to this secrion is pending or additional data on the individual has been collected or creaced. The responsible authority s6a11 provide copies of the private or public data upon request by the individual subject of the data. The responsisible authority may require the requesting person w pay the actual costs of tnaking,cemfying,and compiling the copies. The responsible authority shall comply immediacely,if possible,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 not possible. If he cannot comply with the request within that time,he shall so inform the iadividual,and may have an additional five days within which to comply with the request,excluding Satuidays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may wntest the accurdcy or completeness of public or private data conceming hitnself. To exercise this right,an individual shall notify in writin�the responsble authority describing dse 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 narned by the individual;or(b)nodfy the individual that he believes the data to be correcL Data in dispute shall be disciosed only if the iadividual's statement of disagreement is included wid�the disclosed data. The determinadon of the responsible audiority may be appealed pursuant to the provisions of the admiais�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 permit or license from the City of Orono or any of its departments may require you to furnish certain private or confidential information. � You aze notified that: 1. The information you fumish 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 shazed 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. �,�� e e �1-�-�/�2� - First— Mid e Last �s�y�g C�.� o� `�� Aaa��c�� r/i� ;✓ ;� �l.,J �S 3�i'7 9 s Z -�i�Y��iv City State Zip Phone I understand my rights as stat d above. �� f�� Signature