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� � Sec.13.04 RIGHTS OF S[JBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal data concerning himself shall be informed of: (a)the purpose and intended use of the requesred data wi[hin the collecting§tate agency,polidcal subdivision,or statewide sysum; (b)whether he may refuse oY is legally required to supply the requestr.d data;(c)any laiown coasequence arising from his supplying or refusing to supply private or confidendal data;and(d)the idendry of other persons or endries authorized by state or federal!aw to receive the data. This requiremenc shall not apply when an individual is asked to supply invesdgadve data,pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav alace the noace required under this subdivision in the individual income tax or propertv taz refund instmctions inscead 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 stored data on individuals,and whe[her it is classified as public,private or confidendal. Upon his further request,aa individuai who is the subjecc of stored private or public dara on individuals shall be shown the•data wichout any charge to him and,-if he desires,shall be informed of the content and meaning of fiat daca. Afur an individual has been shown[he private data and informed of i[s meaniag,the data need not be disclosed to him for six months thereafter unless a dispute or acrion pursuant to this secdon is pending or addidonal da[a on the individual has been collected or created. The responsible authority shail provide copies of the private or pubtic data upon request by the individual subject of the dara. The responsible authority may require the requesring person to pay the actual costs of making,certifying,and compiling the copies. The rosponsible authoriry shall compiy immediately,if possible, with any requesc made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediace compliance is not possible. If he cannot comply with the requesc within that time,he shall so inform[he 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 compleceness of public or private data conceming himself. To exercise this right,an individual shall notify in writing the responsible authority describing[he nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of inaccunte or incomplete data, including recipients named by the individual;or(b)nodfy the individual that he believes the data to be correcc. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determinadon of the responsible authority may be appealed pursuant to the ptovisions of the administrative procedure act relating co 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 pemut 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 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. � �+q�,� �� Yn U�s' � id e O �t F�.�3� � - � � Address R'�it/1� �_ �"v C/�d'�� / Z- // / �/ / � //K� v� City State Ztp Phone I un � d rig state above � gnamre