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t � Sec.13.04 RICHTS 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 5et forth in this section. Subd.2. Infonnation required to be given individual. An individual asked to supply private or conFdential data conceming himself shall be infonned of: (a)the purpose and intended use of the requested data within the coltectin�state agency,poli[ical subdivision,or statewide system;(b) whether he may refuse or is legally required to supply the requested data;(c)any known consequence arisin�from his supplying or refusing to supply private or confidential data;and(d)the identity of other persons or entities authorized by state or fedeial law ro receive the data. This 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 commissioner of revenue mav place the notice required under this subdivision in the individual income tax or propertv tar refund instructions instead of on those fonns. Subd.3. Access to data by individuaL Upon request to a responsible authoriry,an individual shall be infonned 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[he subject of stored private or public data on individuals shall be sho�m the data without any charge to him and,if he desires,shall be infonned of the conten[and meaning of that data. After an individual has been shown the private data and infortned of its meaning,the data need not be disdosed to him for six months[hereafter 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 uponrequest by the individual subject of the data. The responsible authority may require the requesting person to pay the actual costs of makino,ceRifying,and compiling the copies. The responsible authoiity shall compiy immediately,if possible,with any request 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 within that time,he shall so infonn the individual,and may have an additional five days within which to comply wi[h the request,exduding Saturdays, Sundays and lega]holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data conceming himselE To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement. The responsible authority shall within 30 days either. (a)cotrect the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,including recipienLs named by the individual;or(b)notify the individual that he believes the data to be co�Tect. Data in dispute shall be disdosed only if[he individual's statement of disa�eement is included with the disclosed data. The detennination of[he responsible authority may be appealed pursuant to Ihe provisions of[he administrative procedure ac[relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04,Subd.2,"Rights of subjects of data",we�vould 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 infonnation you furnish will be used to detennine 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 �vith 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. ur full nam�required to p ocess this application or pemiit. First 1iddle Last l� -�� l Z5� ��,�. /U Addr � �..____ City StatC Zip Phone I understand my ria ts as s -- � _ Signature � ;�