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� ' Se�.13.04 RIGHTSOFSUBJECTSOFDATA ; Subdivision 1. Type ojdata The rights of individua/on whom the datp is stored or to be stored shall be as set forth in this section. � � Subd.2. Injormation required to be given individuaL An individu4l asked Jo supply private or confidential dala concerning himse f shall be informed of (aJ the purpose and intended use of the requested data within the co/lecting state agency,politicol subdrvision,or statewide ' system;(bJ whether he may refuse or is/egally required to supply the requested data;(c)arry known coruequence arising from his supplying or refasing to supply private or corofidenlial data;and(d)the identity of other persons or entities authorized by stale or federa!law to receive!he data. This requrrement shall not apply when an individual is asked to supply investrgative data,pursuant to section 13.82, subdivision S, to a/aw enforcement o�cer. The commissioner ofrevenue mav nlace the notice required under this subdrvision in!he individual income tax or nronertv!ax refund inshvctions instead of on those forms. ° Subd.3. ACcess lo data by individuaL Upon request to a responsible authority,an individua!shal!be informed whelher he is the subject of srored data on individuals,and whether it is classrfied as public,private or conJdential. Upon hrs further request,an individual who is!he subfect of stored prrvote or publrc dato on indrviduals shol!be shown the data without any charge to him and,if he desires,shall be informed of ' the content and meaning of that data. Af[er an rndrvidual has been shown the private data and informed af its meaning,the data need not be drsclosed to him for six months thereafter unless a dispute or action pursuant to this section is pending or additional data on!he individual has been col/ected or created. The responsible authority shall provide copies of the privnte or public data upon request by the indrvidual subject of the data. The responsrble authority may require!he requesting person lo pay the actual cosls of making,certifying,and compiling the copies. The responsrb[e authoriry shall comply immediately,ifpossible,with any requesl made pursuant to this subdivision,or withrn five days oJthe date of the request,excluding Saturdays,Sundays and legal holidays,rf immediate compliance is not possib/e. I,rhe cannot comply with the reques!within that time,he shallso inform the individual,and mcry have an additional frve days withix which to comply with the request,excluding Saturdays,Sundays and legal holidays. Subd.4. Procedure when data is not accurale or comp[eta An individual may contest the accuracy or completeness ofpublic or private data concerning himself. To exercise this right, on rndividuaJ shal/notify in writing the responsible authority describing the nature of the disagreement. The responsible authority shall within 30 days either: (a)correct the dalafound to be inaccurate or incomplete and attempllo noi� � past recipients o,f'inaccurate or incomplete data,rncluding recrpi�nts named by the individual;or(b)not�the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the indrvidua!'s slatement of disagreement is inc[uded with the disclosed da1a. � The determrnation of the responsibJe authority may be appealed pursuant to the provisions of the administratrve procedur�act relating � to cantested cases. ' DATA PRI[�ACYADVISORY ,' In accordance with M.S.13.04,Subd.2,'Rights of subjects oJdata';we would like to rnform you that your reguestfor a permit or license � froml the City of Orono or any of its departments may requrre you lo furnish certain private or confidential information. You trre notified that: 1. The information you furnish will be used to determine your qualification for the permit or license requested. 1. You may refuse to supply data,but refusal may requrre thtrt the City derry the permit or license. 3. The information may be shared with other[ocal,state or federal agencies to the extent necessary to process the permrl or license. 4. I,jyour requested permit or license requires Counci!action lo approve,some information may become public. S. You have certain rights under M.S.13.04(see following pageJ to review prrvate data on yourself. 6. Your full name rs required to process lhis application or permit. ' PLEASE PRINT � i � I First Middle Last ' Address �j" � �� • � `l �� L City State Zip Phone�� '� � 1� I un er n my rg s stated above. Si ure 10