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Sec.13.04 RiGATS OF SUBJECTS OF DATA Subd.1. Type of data. T'he rights of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2.Information required to be given individual.An individual asked to supply private or confidential data conceming himself shall be informed of. (a)the pwpose and intended use ofthe requested data within the collecting state agency,polirical 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 confidential data;and(d)the identity of other persons or eMities authorized by state or federal law to receive the data 7'his requirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. The cottunissioner of revenue may�lace the notice reguired under this subdivision in the individual income tax or�oeriv taat refund instructions instead of on those fomis. Subd.3.Access to data by individual. Upon request to a responsible suthority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data without any charge to him and,if he desires,shall be infonned 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. T'he responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The re5ponsible authority may require the requesting pe�son to pay the actual cosis of making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivisioq or within five days of the date of the request,excludmg Saturdays,Simdays and legal holidays,if immediate compliance is not possible.If he cannot comply with the request within that time,he shali so inform the individual,and may have an additional five days within which to comply with the request,e�ccluding 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 himself.To exercise this righ�an individuat shall notify in writing the responsible authority describing the nature of the disagreement.The responsible auUwrity shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients 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. T'he determination of the responsible suthority may be appealed pursuant to the provisions of the administrative procedure act relating to contested cases. DATA PRIVACY ADVISORY In acxordance with M.S.13.04,Subd.2,"Rights of subjects of data",we would like to inform you that your request for a petmit or license from the City of Orono or any of its departments may require you to furnish certain private or confidential infortnation. You are notified that: 1. The information you furnish will be used to determine your qualificaUon 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 e�ctent 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 requited to process this application or permit. �1�4�ID `'b , �'��DG� � First Middie I.ast ��fD� E, UI��„� � �-� Address ��1��z�� v1.�., ��t 9�a -z��'��z c��y sah z� reo� I und tand my rights as stated above. � �� Signa re 33