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/ � c .1 . .i Sec.13.04 RIGFTTS OF S[JBJECTS OF DaTA Subd. 1. Type of data. The rights of individual on whom[he data is stored or co be stored shall be as set forth in this secaon. Subd.2. Information reqirired to be given individual. a,n individual asked to supply private or confidendal data concerning himself s6a11 be infocmed of: (a)the purpose and inunded use of the requesud data within the collecang�tate agency,polidcal subdivision,or sratewide system; (b)whe[het he may refuse oY is legaily required to suppiy the requested data;(c)any lrnown consequence arising from his supplying or refusing to supply privace or confidendal dara;and(d)the idenary of ocher penons or enddes au[horized by sta[e or federnl law to receive the data. This requiremenc shall not apply when an individual is asked to supply invesdgadve data,pursuanc to secdon 13.82,subdivision 5, to a law enforcement officer. The commissioner of ro�enue mav place the nodce rewired under this subdivision in the individual income tax or properN taz refund instrucuons instead of on those forms. Subd.3. Access to data by individual. Upon requesc to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuais,and whether it is classified as public, privace or confidendal. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the dara wi[hout any charge to him and,�if he desires, shall be informed of the content and meaning of that dara. After an individual has been shown che privau data and informed of its meaning,the data need not be disclosed to him for six mon[hs thereafter unless a dispuu or acdon pursuanc to this secdon is pending or addidonal data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require che requesung person to pay the actual cosu of making,certifying;and compiling the copies. The responsible authority shall comply immediately,if possible,with any request made pursuant co 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 rime,he shall so inform the individual,and may have an additional five days within wtuch 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 pubiic or private data concerning himself. To exercise this right,an individual shall nodfy in writing the responsibie authority describing[he nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of inaccurate or incomplece data, including recipients named by[he individual;or(b)nodfy the individuai thac he believes the dara to be correct. Dara in dispuce shali be disclosed only if rhe individual's statement of disagreement is included with che disclosed data. The determinaaon of the responsible authoriry may be appeated pursuant to the provisions of the administrerive procedure act relating to conrested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Ri¢hts 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 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. First Vfiddle Last Address City State Zip Phone I understand my righ stated a ve. - � /� Signamre