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! Sec.13.04 RIGH'TS OF Si1BJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set fonh in this secaon. Subd.2. Information required to be given individual. An individual asked to suppiy private or confidenaal data concerning himself shall be informed of: (a)the purpose and intended use of the requested data wi[hin the collecdng'state agency, polidcal subdivision,or statewide system; (b)whether he may refuse or is legally required ro supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply private or confidendal data;and(d)the idenary of other persons or endries authorized by state or federal(aw to receive the data. This requirement shall not apply when an individual is asked [o supply invesogadve dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of revenue mav pface the norice required under this subdivision in the individual income tax or propertv tax refund instrucdons instead of on[hose 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 data on individuals, and whether it is classified as pubiic, private or confidendal. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown che data wichout any charge to him and,'if he desires, shall be informed of the conte�t and meaning of that data. Afrer an individual has been shown[he private data and infocmed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this secrion is pending or addirional data on the individual has been collected or created. The responsible authority shall provide copies of the privace or public 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 responsibte authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addiaoual 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 himse(f. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. The responsibie authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of inaccurate or incomplete data, including recipienu named by the individual; or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. 'I"ne determination of the responsible authoriry may be appealed pursuant to the provisions of the administra[ive procedure act relating to contested 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 fumish will be used to determine your qualification for the pemut 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 a�encies 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. //� - � , First� _ ' �fiddie � Last . ��-�" �� %�'l/f. %��l Address . - <�� `/ /� Ciry � � � State Zip Phone I understand my rights as stated above. ,-- /, - � ��: � �. � , ��,,�� . �i�%�� - Signature