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. . � • Sec.13.04 RIGHTS OF SLJBJECTS OF DATA Subd. 1. Type of data. The righrs of individual on whom[he dara is stored or to be stored shall be as set for[h in this secdon. � Subd.2. Information reqtrired to be given individual. An individual asked to supply priva[e or confidendal data concetning himself s6all be informed of: (a)the puipou and intended use of the mluesmd data wi[hin ihe collecring§tate agency,polidcal subdivision,or srroewide rysoem; (b)whether he may rofuse or is legally�equired to supply che requesud data;(c)any l�own consequence arising from his supplying or refusing ro supply privace or confidendat data:and(d)rhe identiry of oeher persoas or entiaes authorized by state or federal law to meive the data. This requirement s6a11 not apply when an individual is asked to supply invesdgadve dara,pursuant to secdon 13.82,subdivision 5, to a law enforcement offtcer. The commissioner of revenue mav piace [he nodce required under this subdivision in the individual income rax__o_r prooettv taz refund inswcrions instead of on those forms. Subd. 3. .�►ccess to data by individual. Upon request to a responsibte au[horiry,an individual shall be informed wherher he is che subject of stored dara on individuals,and whecher it is ciassified as public, private or confidendal. Upon his further request,an individual who is[he subject of stored privace or public data on individuals shall be shown the data wiehout any charge W hun and.�if he desires, shall be informed of the con¢nt and meaning of that data. After an individual has been shown the private data and informed of ics meaning,the data need not be disclosed to him for six monchs[hereafter unless a dispute or acdon pursuant to this secdon is pending or additional data on[he individual has been collected or created. The rosponsible authoriry shall provide copies of the private or public data upon request by the individual subjec[of the data. The respoasible au[horiry may require the requesdng person to pay the actual cosu of making,cerafying,and compiling the copies. The responsible authority shall comply immedia[ely,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 noc possible. If he cannot comply with[he requesc within that time,he shall so inform[he individual,and may have an addidona!five days wi[hin which to comply with the request,excluding Saturdays. Sundays and legat holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shal!noafy in writing the responsible au[horiry describing the nature of the disagreemenc. The responsible au[horiry 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[he individual;or(b)nodfy the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's stacement of disagreement is included with the disclosed data. The detertninadon of the responsible au[hority may be appealed pursuant to the provisions of the administradve procedure act reladng to contesced 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 Ciry of Orono or any of its departments may require you to fumish certain private or confidential information. You are notified that: 1. The information you fumish wili 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 rhe 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. .9�� s C�_ Firsc f! �/ 0 /1 Mi(d�die Lasc � � '��B�"t aC4- /Tre .�v ��D Addtess�� /�/Ly �� c�� / V� i� J iF� Ciry State Zip Phone I understand my rights as stated above. C.� Signatu— re�