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� � � Sec.13.04 RIGHTS OF S[TBJECTS OF DATA Subd. 1. Type of data. The righcs of individual on whom[he data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal data conceming himself shali be informed of: (a)the purpose and iatended use of the requesced data wi[hin the collecting�tate agency,political subdivision,or stacewide system; (b)whether he may cefuse oY is legaily required to supply the requesud data;(c)aay Irnown consequence arising from his supplying or refusing ro supply private or confidendal data;and(d)the idenriry of ocher persons or endties au[horized by state or federel law to receive the data. This requirement shall not apply when an individual is asked to supply investigadve dara, pursuanc to secdon 13.82, subdivision 5,to a law enforcement o�cer. The commissioner of revenue mav olace the nodce reauired under this subdivision in the individual income tax or propem taz refund inst�ucdons inscead of on rhose forms. Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of swred data on individuals,and wherher it is classified as public,priva�e or confidendal. Upon his further request,an individual who is the subjecc of stored private or public data on individuals shall be shown che data wichout any charge to him and,�if he desires, shall be informed of the content and meaning of[hat data. After an individuai has been shown the private data and iaformed of its meaning,the data need not be disclosed to him for siz months thereafter unless a dispute or acdon pursuanc to chis secdon is pending or addidonal data on the individual has been collected or created. The responsible authority shalt provide copies of the private or public data upon request by the individual subject of the dara. The responsible authoriry may require the requesting person to pay the actual cosu of making, certifying,and compiling[he copies. The responsible authoriry shall comply immediacely, if possible, wich any request made pursuant to this subdivision,or within five days of the date of the roquest,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he canno[comply with the request within that time,he shall so inform the individuai,and may have an addidonal five days within which to comply with 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 compieteness of public o�private data concerning himself. To exereise this right,an individual shall nodfy in writing the responsible authority describing the nature of ihe disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incompiece and attempt to nodfy past recipienu of inaccurate or incomptete data, including recipien[s named by[he individual;or(b)nodfy the individual tha�he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statemenc of disagreement is included with the disclosed data. The determinadon of the responsible authoriry may be appealed punuant to the provisions of the adminisaative 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 are 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. , � c�M��c ,,�r �L Fir Middle Last �3� ��n1� Jr�� Addross `,n� � /��'� �� / 1 Ciry tate Zip Phone I unders y ri s as stated ab �': Signacu .