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i � Sea13.04 RIGHTS OF SUBJECTS OF DATA Subd.l. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set torth In thts section. Subd.2. Information required to be given individual. An tndividual asked to supply prlvate or contidential data concerning hlmself shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b) whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to suppiy private or confidential data;and(d)the identity otother persons or enttties authorized by state or federal law to recetve the data. This requirement shall not apply when an individual is asked to supply investlgative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue mav alace the notice reauired under this subdivision tn the individual income tax or nrooertv tax refund instructions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shail be informed whether he is the subject of stored data on individuais,and whether it is classi�ed as public,private or confidential. Upon his further request,an fndividual who is the subject of stored private or public data on individuals shall be shown the data withaut any charge to him and,if he destres,shall be in[ormed of the content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by the Indivtdual subject of the data.The responsible authority may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responstble authority shall comply immediately,if possible,with any request made pursusnt to this subdivision,or within fve days of the date ot the request,excluding Saturdays,Sunduys and legal holidays,if immediate compltance is not possible.If he cannot comply with the requestwithin that time,he shall so inform the Individual,and may have an additional flive days within which to comply with the request,excluding Saturdays,Sundays and legal holidays. Subd.4. Procedure whcn data is not accurate or complete. An individual may contest the accuracy or completeness of publte or private data concerning himseif. To exercise this right,an individual shall notify In writing the responsible authority describing the nature otthe disagreement. The responsible suthorlty shall within 30 days either: (a)correct the dats found to be insccurate or lncomplete and attempt to notify past recipients of inaccurate or tncomplete data,including recipients named by the ind(vidual;or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the indlvidual's statement oCdisagreement is included with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the administrative 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 furnish 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 Middie Last Address City State ZIp Phone I understand my rights as stated above. Signature