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� _.. , Sec.13.04 RIGHTS OF SUBJECTS OF DaTA Subd. 1. Type o[data. The righ[s of iadividual on whom rhe data is scored or co be stnrd sha11 be as set forth in this sectioa Subd.2. Information reqirired to be given individual. An individual asked w supply private or con5dendal dara conceming himself shall be informed of: (a)the purpose and inunded use of the requesred dara widiin the collecdng SYate a�ncY.poimcal subdi�uion,or stacewida ryscem; (b)whether he may refuse oY is legally required to supply the requested data;(c)any known consequen�arising frnm his supplying or refusing to supply privace or confidential data;and(d)the idenriry of other persons or enriaes au[horized by stace or federel law to rxeive the dara: This requiremenc s6a11 not apply when an individual is asked to supply invesrigadve dara,pursuant m secaon 13.82,subdivision 5,to a law enforcement officer. The commissioner of rovenue mav place the nodce rewired under this subdivision in �he individual income raz or propern rez refund insttucaons instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible au[horiry,an individual shaII be informed whether he is che subject of stored data on individuals,and wherher it is ciass�ed as public,private or confidential. Upon his further izquest,an individual who is the subject of stored piivate,or public data on individuals shall be shown che data widiout any charge to him a�,if he drsires,shall be informed of the content and meaning of chat data. Afur an individual has been shown rhe private data and iaformed of iu nYaning,the data need not be disclosed oo him for siz monfis[hereafter unles5 a dispute or action pursuant to this section is pending or addidonal dara on the individual 6as been collected or crea[ed. The responsible authoriry shall proyide copies of the private or public da[a upon request by the individual subjecz of rhe dara. The responsible authoriry may require the requesting person ro pay the actual costs of making,cemfying,and compiling the copies. The responsible authority shall comply immediately, if possible,wi[h any request made ptusuant to�is subdivision,or wichin five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediace compliance is mc possible. If he cannot comply with che request within tttat dtde,he shall so,inform the individual,and may have an addiaonai five days wi[hin which oo compiy with the request,exc!uding Sazurdays, Sundays and legat holidays. Subd.4. Procedure when data�is not accurate or complete. An individual may contest�e accurdcy or completeness of public or private data conceming himself: To exercise Uii's right,an individual shall nodfy in writing the iesponsibie aurhority describing the naturo of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or irsomplere and attempt to nodfy past recipienu of inaccunte or incomplete data, including recipients named by che individual;ar(b)nodfy the iadivi�al thac he believes the dara to be correct Data in dispute shall be disctosed only if the individual's staumenc of disagreemenc is included wirh[he disclosed data. The determinadon of the responsible authoriry may be appealed pursuanc to die provisioas of the administrarive procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data", we w-ould 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 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 Ciry 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. g, You have certain rights under M.S. 13.04 (available upon request) to re�-iew private data on yourself. 6, Yonr full name is required to process this application or permit. (��s Fusc �� u;aa�e� � � � � n _L�3J ► • A�ress 1 ' 1(1 ��'j�`'i � ��.� ��r rY� � v�� /. C�ty gta[e Z.p Phone I understand my rights as stated above. S S' ture