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l Sec.13.04 RIGHTS OF SLJBJECTS OF DATa Subd. 1. Type of data. The righcs of individual on whom che data is stored or co be stored shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. P.n individual asked to supply private or confidenrial data conceming himself shall be informed of: (a)che purpose and in[ended use of the requesud data wichin the collecting'state agency, poliacai subdivision,or sracewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidendai data;and(d)[he idendry of o[her persoas or enades auchorized by state or fedecal law to receive the data. This requirement shall not apply whtn an individual is asked to supply invesdgarive dara, pursuan[to secdon 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of re�enue mav place the nodc rewircd under this subdivision in the individual income tax or propem tax refund ins[ruccions instead of on those forms. Subd. 3. Access to data by individual. Upon requesc to a responsible au[horiry,an individual shall be informed whether he is the subject of stored data on individuais,and whe[her it is cfassified as pubiic,priva�e or confidenaal. Upon his further request,an individual who is the subject of stored private or public dara on individuals shall be shown[he dan wirhout any charge to him and, if he desires, shall be informed of the content and meaning of that data. After an individual has been shown[he private data and informed of ics meaaing,the dara need not be disclosed to him for six mon�hs[hereafter unless a dispute or acdon pursuant to chis secdon is pznding or addidoaal data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by[he individual subject of the data. The responsible authoriry may require the requesang person to pay the actual coscs of makin¢, cerufying,and compiling the copies. The responsibfe auchoriry shall comply immediacely, if possible, wieh any request made pursuant to this subdivision,or within five days of the date of che requesc,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shatl so inform[he individual,and may have an addidonal five days within wtuch to comply wich the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of pubiic or private data concerning himself. To exercise chis right,an individual shall noafy in wriang[he responsible au[horiry describing che nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct che data found to be inaccurate or incomplece and attempt to noafy past recipients of inaccurate or incomplece data, including recipients named by the individual; or(b)nodfy the individual thac he believes[he data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with[he disclosed data. The determinarion of the responsibie auchoriry may be appealed pursuanc to the provisions of the administrative procedure act relating to contested cases. . DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Ri;hts 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 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 ocher local, state or federal agencies to the eztent necessary to process the pernut �r license. 4. If your requested permit or license requires Council action to approve, some information may become public. j. 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. _ ,�, ��'v�S � `\ �;� ;' � X Firsc �Siddle Lasc �� 3 � r� .�L�� L'�-�s'� T� /� c;_ ,n/-� � Addre�� ; o� �y, ,� � �,s��y � ��-�SsG��a Ciry Srate Zip Phone I understand my rights stated above. t � �� � Signam�e `� �