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Sec.13.04 RIGH'TS OF SUB.TEC'I'S OF DATA Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. An indiv�dual asked to suppty private or confidendal data conceining himtelf sha11 be informed of: (a)the purpose and intended use of the requested data within the collecring'state agency, polidcai subdivision,or statewide rysoem: (b)whether he may rtfust or is legally required to supply the requested data;(c)any known consequence arising from his supplying or tefusing to supply privace or confidential data;and(d)che idenary of other persons or endries authorized by state or federal law to receive the data. This requirement shall no�appty when an individual is asked to supply invesrigaave dara, pursuant to secrion 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav place the norice required under this subdivision in the individual income raz or propem taz refund ins[rucrions instead of on[hose forms. Subd. 3. Access to data by individual. Upon request to a responsible aurhority,an individual shall be informed whether he is the subject of stored data on individuals,and whecher it is classified as public, private or co�dendal. Upon his further request, an individual who is the subject of stored pnvate or public data on individuals shall be shown che data wi[hout any charge to him and,�if he desires, shall be informed of the concenc and meaning of that dara. After an individual has been shown the privace data and informed of ia meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this secdon is pending oc addiaonal data on[he individual has been cotlected or created. The responsible authoriry shall provide copies of the private or pubfic data upon request by ihe individual subject of the data. The responsible authoriry may require the requesdng penon to pay the actual costs of making, cerdfying, 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 the date of the request,ezcluding Sacurdays,Sundays and legal holidays,if immediate compliance is noc possible. If he cannot comply with the request within[hac cime,he shall so inform the individual,and may have an addidooal 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 au[horiry describing the nature of the disagreement. The responsibfe au[horiry shall within 30 days either: (a)correc[the data found to be inaccurate or incomp(ete and attempc to nodfy past recipien¢of inaccurate or incompiete data, including recipienrs named by the individual; or(b)notify the individual that he believes the data to be correct. Dara in dispute shall be disclosed only if the individual's stacement of disagreement is included with the disclosed data. The determination of the responsible au[hority may be appealed pursuant to the provisions of the administradve procedure act relating to con[ested 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 fumish certain private or confidential information. You are notified that: 1. The information you furnish will be used to determine your qualification for the permit or license requested. 2. You may retsse to supply data, but refusal may require that the Ciry 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 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 n .e is required to process this applicati r permit. �� ' _ � -� � � - . - � First � �Middle � Last //�/1r\-- � � < <'--'-� 7 � Add � ; ; i?r �.�� J C.- � / i ^State Zip Phone f" I understan � � ts as stated above. '�%R , ,� ;1;' ;. , � � ��. s�� n� ` �