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Sea13.04 RIGHTS OF SCTB.TECTS OF DATA Subd. 1. Type of data. The righcs of individual on whom che dara is stored or co be stored shall be as set forth in[his secrion. Subd.2. Information reqtrired 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 requested data wi[hin @►e collecting�tate agency,poliacal subdivision,or statewide sysum; (b)whe[her he may refuse oY is legally required to supply the requested data:(c)any known consequence arising from lus supplying or refusing to suppty priva[e or confidential data;and(d)the idendry of other persons or enrities aurhocized by sta[e or federa!law to receive the data. This requirement shal! not apply when an individual is asked to supply invesrigadve data, pursuan�to section 13.82,subdivision 5,to a law enforcement officer. The commissioner of re�enue mav place the nodce rewired under this subdivision in the individual income rax or proaem tax refund instcuccions inscead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whecher it is classified as public,private or confidenrial. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown rhe dara wichouc any charge to him and,-if he desires,shall be infocmed of the content and meaning of[hat data. After an individual has been shown the private dara and informed of iss meaning,the daCa need not be disclosed to him for six months thereafter unless a dispute or acaon pursuanc w this secrion is pending or addidonal data on the individual has been cotlected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesdng person to pay the acmal costs of making,certifying;and compiling the copies. The responsible au[horiry shail comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Santtdays,Sundays and legal holidays,if immediate compliance is not possibie. If he cannot comply with the request within chat time,he shall so inform the individual,and may have an addidonal five days wirhin which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. M individual may contest the accuracy or completeness of public or pri�•ate data concerning himself. To exercise this right,an individual shall noafy in writing the responsible authoriry describing[he nature of the disagreement. The responsibte authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to noafy past recipients of inaccunte or incomplete data, including recipiencs named by the individual;or(b)norify the individual thac he believes the daca 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 provisions 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 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. Firsc Middle Last Address City State Zip Phone I understand my rights as stated above. . Signature