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Sea13.04 RIGHTS OF SUBJECTS 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 forth in this section. Subd.2. Informallon required to be given individuai.An individual asked to supply private or coofidenrial data conceming himseif shall be informed of: (a)the purpose and iatended 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 supply private or co�dential data;and(d)the identity of other persons or entities authotized by state or federnl Iaw to receive the data.1'his requirement shatl not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. Th¢CottLmiccinner nf�eVCtlue mA��Dlsce ihe nntirp repuL�l undef thls SubdlVlcion ln e' dividu+l Lcome tax or pro�g_r(y tax refii� instructi4ns mstead of on tho�forms. Subd.3. Access to data by individuat. Upon request to a responsible authority,an individual shall be infom�ed whether he is the subject of stored data on individuals,and whether it is classified as public,private or confidenrial. Upon his further request,an individual who is the subject of stored private or public data on individuals shatl be shown the data without any charge to him and,if he desires,shall be informed of the content and meaning of that data. After an individual has been shown the private data and infortned of its meaning,Uie data nced not be disclosed to him for six months thereafter unless a dispute or action pursuant to this section is pending or additional data on tfie individusl has been collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject ofthe data. The rtsponsible authority may require the requesting person to pay the acWal cosis of making,certifying,and compiling the copies. The responsible authority s6a11 comply immediately,if possible,with any request made pursuant to this subdivisioq or within five days of the date of the request,excluding Saturdays,Sundays and legal6olidays,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 which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete.An i�ivid�ml may contest the accuracy or completeness of public or private data conceming himself. To exercise this right,an individual shall notify in writiag ffie responsible authority descnbing the nature of the disagee�nt.The responsible suthority shall within 30 days either: (a)cornct the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,including recipients 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 individuaPs statement of disagreement is included wit6 the disclosed data The determinarion of the responsible suthority 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 fi.unish 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 applicarion or permit. � First Middle I.ast . � Addrc C..�f�i.�� itil !� S �� 9!��a2 7� , City Shte Zip Phoae I under nd y ts as ted above. Sign re RPcrt Fnrm ,,,,