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'} 1 Sec.13.04 RIGHTS OF SUBTECTS OF DATA Subd. 1. Type of data. The rights of i�lividual on whom the data is stored or to be stored shall be as set forth in this section. Sl�bd.2. Information required to be given individual. An indivttival asked ro supply private or confidendal data concerning himself shall be informed of: (a)the p��pose atid i�ended 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 daha;(c)any lmown consequence arising from his supplying or refusing to supply private or confidential data;u�d(d)the idenriry of other persons or entities authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked w supply invesdgadve data,pursuant to section 13.82, subdivision 5, to a law enforeement officer. The c�m�++��sioner of revern�e mav nlace the nodce reauired under this subdivision in the ir�ividual income tax or orocertv tax refund instrucdons instead of on those forms. L Subd.3. Access to data by individual. Upon request to a responsible authoriry,an i�ividual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or confidential. Upon lus further request,an i�ividual who is the subject of stored private or public daha on individuals sl�all be shown the data without any charge to him and,if he desires,shall be informed of the conunt 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 w him for six months thereafter unless a dispute or action pursuant to this sx6on is pe�ing or addirional data on the individual has been collected or created. The responsible authoriry shall provide copies of die privau or public data upon request by the individual subject of the data. The responsible authoriry may require the requesdng person to pay the actual cosu of making,certifying,and compiling the copies. • The responsible authority shall comply immediately,if possible,with an}+request made pursuant to tlris 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 witLin that time,he sl�all so inform the individual,and may have an additional five days within which to comply with the request, excluding Saturdays,Su�ays and legal holidays. S�bd.4. Procedure when data is not accurate or complete. M individual may contest the accuracy or completeness of public or private data wncerning himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccarate or i�omplete and attempt to notify past recipients of inaccurate or i�omplete data,i�luding recipients named by the individual;or(b)notify the i�iividual 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. The detemrinadon of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relating W 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 fumish will be used to determine your qualification for the permit or license requested. 2. You may refuse to supply data,but refvsal may require that the City deny the permit or license. 3. The information may be shazed 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. , -��,�( r�� 1C.`�- �-� �'JC-�1 c�,1�•�c-�� - -�;�� Middle last \?�'� I �1 - ��ti`� ��x � s� Adc}tess D f � ` il'T1n �� 7��"�� -7 C•�c.�� J l � , � .f,, Ciry - State Zip Phone I understand my rights as tated bove. . ' �, � l '� �t � �gnature 6