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Sec.13.04 RIGFTTS OF SUBJECTS 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 confidenrial data concerning himself shall be informed of: (a)the purpose and intended use of tbe requesred data wi�hin the collecting'state agency,polidcal subdivision,or sratewide system; (b)whe[her he may refuse oY is legaily required to supply the requested data;(c)any known consequence arising from his supplying or refusing to suppty private or confidendal data;and(d)the idenriry of other persons or enddes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesdgadve dara, pursuant to secdon 13.82,subdivision 5, to a law enforcement officer. The commissioner of revenue mav pface the nodce reouired under chis subdivision in the individual income rax or ocopem rax refund instructions instead of on those forms. Subd.3. Access to data by individual. Upon request to a respo�sible authority,an individual shall be informed whether he is the subject of s[ored data on individuals,and whe[her it is classified as public, private or co�denaai. Upon his further request, an individual who is the subject 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 that data. After an individual has been shown the privace dara and informed of irs meaning,the data need not be disclosed to him for six monrhs thereafter unless a dispute or acdon pursuant to this secdon is pending or addidonal dara on the individual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the actual costs of making, cerrifying,and compiling the copies. The responsible authoriry shall comply immediately, if possibfe,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 immediace 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 conceming himself. To exercise this right,an individual shall nodfy in wriring the responsible authoriry describing the 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 inaccucate or incomplete data, including recipients named by the individual; or(b)nodfy the individual that he believes the data to be correcG Dara in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determinarion of the responsible authority may be appealed punuant to the provisions of the adminis�adve procedure act reladng 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 Ciry 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 detemune 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 a plication or p 't. � � , � �� d% �� �� , ti Fint ] M' e ,� Last � / -'� �, S " v Address , -- - '' � �S � � �� „ � J �i � C� �V? City 4 State Zip Phone I un rstand my rights as stated afiove. '�> '� _ � Signature