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i; -�.. . . . " , , �� _ ��/ ,�`�, Sec.13.04 RIGHTS OF SUBJECTS OF DATA � • � ` Subdivrsron 1. Type of data. The rights of indrvidual on whom ihe data is slored or to be stored shall be as set forth in thrs sectron ��, � �r� Subd.2. Informalton required to be given individuaL An individual asked to supply private or confidential data concerning himselJ !� shall be injormed of (a)the purpose and intended use of the reguesred data withrn the collecting s�ate agency,polirieal subdrvision,or statewide system;(bJ whether he may refuse or is legally reguired to supply the reguesled data;(c)any knoivn consequence arisingfrom his supplying or refusing to supplyprivale or confidential da1a;and(dJ the identity of otherpersons or entities authorized by stale orfederal latin to receive the data. ' This requirement shall not apply ivhen an individua!is asked to supp/y r�rvestigative data,pursuant to section 13.82, subdivision 5, lo a Imv enforcemenl o�ce�. , The commissioner o{revenue mavplace the notice required under lhis.�irbdrvrsion in the individual rncome 1ax or proDe�tv tax refund inscructions instead of on Jhose forms. Subd.3.Access fo�data by individuaG Upon request lo a responsible authoriry,an individual shall be rnformed whelher he is the subject of stored data on individuals,and N�heiher it is classified as pubtic,private or confidential. Upon his further reguest,a»indivrdual»�ho is the subject of slored private or public data on indrviduals shall be shown!he data without any charge!o him and, rf he desires,shal!be informed of the content and meaning of that data. After an individual has been shown the private data and rnformed of its memting,the data»eed not be disclosed to him for six months thereafler unless a dispule or action pursuanl lo this section is pending or additional data on tlre individual haS 6een collected or created. The responsibPe authoriryshall provide�copies of the private or public data upon request by the indivrdual subjecf of the data. The responsible authority may require the requesting person lo pay the actual cosls of makrng,cert�ing,and compiling the copies. The resporrsible authority shall comply immediately,if possible,wilh any request made pursuant to lhis subdivision,or x�ithin ftve days oJthe date of the request,excludrng Saturdays,Sundays and legal holidays,if immediate compliance is not possrble. If he cannot comply ivith the request ivrlhrn lhat time,he shal/.so inform 1he individual,and may have an additional frve days�+�ithin ivhich lo comply ivilh ihe requesl,excluding Saturdays,Sundays and legal holidays. � Subd.4.Procedure when data is not accurate or complete An rndividual may conrest the accuracy or completeness ofpubl rc or prrvate data concernrng himself. To exercise this rrght, an individual shall no1�in writing the responsrble authority describing the nature of the disagreement. The responsrble authoritysha/1 within 30 days either: (aJ correct the datafou�:d to be rnaccurate or incomplete and attempt to not� past recipients o,�inaccurate or incomplete data,including recipients named by the individual;or(b)nbt�the indrvidual that he believes the data lo be correct. Data in dispute shal!6e disclosed only if the individua!'s statement ofdisagreement rs included with the disclosed dala. The determination of the responsible aulhority may be appealed pursuant to the provisions of the administratrve procedure ac!relating to eontested cases. DATA PRIVACYADVISORY In accordance with M.S.13.04,Subd.2,'Righls ofsubjects oJdata",we would like fo inform you that yourreguest for a permit o�license from the City of Orono or any of its deparlments may requrre you to furnish cerlain prrvate or confrdential information. You are notified that: I. The information you furnish will be used!o determine your qualrfication for the pern:it or license requested. 2. You may refuse!o supply data;but refusa!may requrre thht!he City deny the permil or license. 3. The rnformatron may be shared ivith other local,stale br federal agencies to ihe eztent rtecessary to process the permit or license. 4. If your requested permit or license requires Council actibn to approve,some informalion may become public. 5. You have certain rights under M.S.13.04(see fo/lowing pageJ to review private data on yourself. 6. Your full name is required to process ihis applicafion or permit: PLEASE PRINT �l QSo�n If�w�.n��n WL� First Middle Last ��3 D 2�Ok``�f � Address ^ �e.�.,� �r ac,�.�-�, 1�� JCe-�-` : C�ry Stale Zip Phone I unde rights as stated above. `�Z 7�2''� v Signature /0 / � , ' � t - "