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Sec.13.04 RIGHTS OF S[JBJECTS OF DATA Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be stored shall be as set forth in this secaon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidenaal data conceming himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting State agency,politicai subdivision,or stacewide sysum; (b)whether he may refuse oY is legally required to supply the requesud data;(c)any�own consequence arising from his supplying or refusing to suppty privau or confidential dara;and(d)the identiry of other persons or enddes authorized by state or federal law to receive the data. This requiremenc s6all not apply when an individual is asked to supply investigadve dara,pursuant to secaon 13.82,subdivision 5,to a law enfo�ement officer. The commissioner of re�enuo mav place the nodce reauired under this subdivision in the individual income raz or pro�ertv taz refund instrucaons instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of storod data on individuals,and whe[her it is class�ed as public,privace or confidenaal. Upon his funher request,an individual who is the subject of swred private or public data on individuais shall be shown the da[a wirhout any charge to him and;if he desires,shall be informed of the content and meaning of chat data. After an individual has been shown the private data and informed of iu meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acdon pursuant co tivs secdon is pending or addidonal data on the individual has been collecud or created. The responsible au[horiry shall provide copies of the privau or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the acmal costs of making,certifying,and compiling the copies. The responsible authority shall comply immediately, if possible,with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saardays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addidonal 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 individual may contest the accuracy or completeness of public or private data concerning himseif. To exercise this right,an individual shall nodfy in writing the respoasible authoriry describing�he nature of the disagreement. The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to noafy past recipienu of inaccurate or incomplete dara,including recipients named by the individuat;oc(b)nodfy 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. The decermination of the responsible authority may be appealed pursuant to the provisions of the adminisnacive procedure act retating 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 fumish 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 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 publia 5, You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. fi, Your full name is required to process this application or permit. � ,�� Q�Z� �� First M'ddle �t �=1�13� �"d c c �vtrU - Addross —T ., � � � /�jj 3.S�o� ('/v�-��3��-Z C�ry State Zip Phone I understand my rights as stated above. igna/: