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� Sec.13.04 RIGHTS OF SLJBJECTS OF DATA Subd. 1. Type of data. The righcs of individual on whom the dara is stored or to be stored shall be as set forth in this secdon. Subd.2. Information required to be given iadividual. An individuai asked to suppiy private or confidendal data concerniag himself shall be informed of: (a)the purpose and incended use of the requested dara within the collecting§tate agency,poGdcal subdivision,or sta[ewide system; (b)whether he may retux or is legally roquired to supply the requested data;(c)any imown consequence arising from his supplying or refitsing to supply privace or confidenaal data;and(d)rhe idendry of other peaons or enades authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesdgadve dard, pursuant to secdon 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue mav piace the nodce required under this subdivision in the individual income tax or vroaertv tax refund insaucaons instead of on those 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 stored dara on individuals,and whecher it is classified as public, private or co�dendal. Upon his further request,an individual who is the subject of stoced private or public data on individuats shall be shown the data wichout any charge to him and:if he desires, shall be informed of the conten[ and meaning of[hat data. After an individual has been shown[he priva[e data and informed of its meaning,the data need not be disclosed to him for six months thereafter uniess a dispute or accion pursuant to this section is pending or addidonal data on the individual has been collecud or created. The responsible authority shall provide copies of the private or pubiic data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the actual cosu of making,cemfying,and compiling the copies. The responsible authority shatl comply immediacely, if possible, with any requesc made punuant to this subdivision,or within five days of the date of ihe request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannoc comply with the reques[ within that time,he shall so inform the individual,and may have an addidonal Five days within which to comply with the request,excluding SaNrdays, Sundays and legal 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 shall notify in writing the responsible authoriry describing the nature of the disagreement. The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past cecipiena of inaccurate or incomplete data,including recipients named by the individual;or(b)nodfy the individuat that he believes the data to be correct. Data in dispuu shail be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determinadon of the responsible authoriry may be appealed pursuant to the provisions of the administradve procedure act relatiag to contested cases. DATA PRNACY 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 pemut or license from the City 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 furnish will be used to detemune 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 pernut 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. � �� ud �' Fi t Middie Last ��L,� L�,�" ��P. lV a� SS P��b�nsd��P Ml� �5�-Y 53 3-03��-- City State Z�p Phone I understand my 'ghts s ted above. Signantre