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i Sec.13.04 RIGFiTS OF SUBJECTS OF DATA Subd. 1. Type of data, The rights of individual on whom[he data is stored or to be stored shall be as set for[h in dvs secdon. Subd.2. Information required to be given individual. An iadividual asked to supply private or confidendal data concerning himself shall be informed of: (a)the purpose and intended use of the requested dara within the collecting§tate agency,polidcal subdivision,or statewide system; (b)whether he may refuse or is legally required to supply the requested data;(c)any Imown coasequence arising from his supplying or refusing to supply privace or confidential da[a;and(d)the idendry of other persons or entiaes authorized by stace or federal law to receive the data. This requirement shatl not apply when an individuai is asked to supply invesdgarive data,pursuanc to secdon 13.82, subdivision 5, to a law enforcemenc o�cer. The commissioner of revenue mav alace the nodce reauired under this subdivision in the individual income tax or propertv tax refund instrucrions instead of on those forms. Subd.3. Access to data by individuai. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and wherl►er it is classified as public, priva[e or contidenrial. Upon 6is fur[her request,an individual who is the subject of stored private or public dara on individuals shall be shown the data wi[hout any charge to him and,-if he desires,shall be informed of the contenc and meaning of that data. After an individual has been shown the private data and iaformed of its meaning,the data need not be disclosed to him for six months rhereafter unless a dispute or acrion pursuant to this section is pending or addidonal data on the individual has been collected or created. The responsibie authority shall provide copies of the private or public data upon roquesc by the individual subject of the data. The responsible auchoriry may require the requesdng person to pay the actual costs of making,certifying,and compiling the copies. The responsible authoriry shall comply immediately, if possible,with any request made pursuant to this subdivision,or within five days of die date of the reques[,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the requesc within that time,he shaU so inform the individual,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 completeness of public or private data concerning himself. To exercise this right,an individual shall norify in writing the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correcc the data found to be inaccurate or incomplete and attempt to noafy past recipients of inaccurate or incomplete data, including recipients named by the individual;or(b)notify the individual that he believes the data to be coaect. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determinacion of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relating to concested 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 pernut or license from the City of Orono or any of its departments may require you to fumish certain private or confidential information. You aze 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 shared 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�_S \v��` r� �c'��c..��. F�� Middle Lasc �Z�d�--�-�'��A��r�s—� Addross ��c'ta�c.c� �1�� n�� ^�� Ciry State Zip Phone I understand my rights as stated above. �� Signature