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Sec.13.04 RIGHTS OF SLJBJECTS OF DaT.+i Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be stored shall be as set forch in this secdon. Subd.2. Information reqirired to be given iadividual. An individual asked to supply private or confidenrial data conceming himself shail be informed of: (a)the pucpose and inttnded use of the requested data within the collecting Ytate agency,poliacal subdivisioa,or sratewide rystem; (b)whether he may refuse or u legally required co supply che requesud data;(c)any 1�own consequence arising from his supplying or refusing to supply • pcivate or confidenrial data;and(d)the idendry of other persoac or enddes aa[horized by state or fedeiai law to receive rhe dara. This requirement shail not apply when an individual is asked to supply invesdgadve dara,pursuant ro secdon 13.82,subdivision 5, to a law enforcement officer. - The commissioner of revenue mav place the nodce reauircd under this subdivision in the individual income tax or arooertv taz refund instrucaons instead of on ehose forms. Subd. 3. Access to data by individual. Upon requesc to a responsibie authoriry,an individual shall be informed whether he is[he subject of stored daca on individuals,and whether it is classified as public, private or confidenaal. Upon his further request,aa individual who is the subject of stored private or public data on individuals shall be shown ehe data wiehout any charge to him and;if he desires, shall be informed of the content and meaning of[hat data. Afur an individual has been shown che privace data and informed of its meaning,the data need not be disclosed ro him for siz monrhs thereafur unless a dispute or acdon pursuanc to [his secaon is pending or addidonal data on the individual has been coliected or created. The responsible au�horiry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible aurhority may require the requesting person to pay the actual costs of making,cerdfying,and compiling the copies. The responsible authoriry shall comply immediacely,if possible,with any requcsc made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request wirt►in rhat time,he shail so inform the individual,and may have an addiaonal five days within which to comply wirh the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may conrest the accuracy or compieteness of public or private data concerning himself. To exercise chis right,an individuat shall noafy in writing the responsibie authoriry describing the nature of the disagreement. The responsible au[horiry shall within 30 days either: (a)correct the data found to be inaccurate or incompiete and attempt to nodfy past recipienu of inaccurate or incomptece data, including recipiencc named by rhe individual;or(b)nodfy the individual thac he believes rhe data to be correct. Data in dispute shali be disclosed only if the individuai's stacement of disagreement is included with the disclosed data. The dearminadon of the responsible authoriry may be appealed pursuant to the provisions of che adminisaadve procedure act relaang 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 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 ri,Phts 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. �,��;� �,�; �1,�.,� ��,�� First Vliddle Last �3�� cs� f�`-� �� Address /7 r �v /��/ -�5 � �� Ciry State Zip Phone I understand my ri hts as stated above. �-�-�-� C�.J�:�- a�--- sisnacu�e