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. I � Sec.13.04 RIGH'TS OF SUBJECTS OF DATA Subd. 1. Type ot data. The righcs of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Informa4on req�rired to be givm individual. An individual asiced W suPPly private or confidendal data conceming himsdf shall be informed of: (a)the pucpose and intended use of the requesrcd data within the collecriag State agency,political subdivision,or statewide sysum; (b)whether he may refuse oti is kgatly required w supply the reqaested dam�(�)anY l�own consequence arising from his supplying or refusing w supply private or confidendal data;and(d)the idendry of o[her persoac or enrides suthorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to suppiy invesdgadve data,punvant to secrion 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue mav alace the nodce rewired under this subdivision in the individual income taz or pronertv tax refund insttucdons 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 swred data on individuals,and wherher it is class�ed as public,private or confidential. Upon 6is fuctber request,an individual who is the subject of stored private or public data on individuals shall be shown ehe data wi[hout any charge to him and,-if he desires,shall be informed of ihe coatent and meazung of that data. Afur an individual has been shown tbe private data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acdon pursuanc to this secaon is pending or addiaoaal data 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 authority may require the ctquesting person to pay the actual cosu of making.certifying,and compiling the copies. The rosponsible authority shall comply immediately,if possibie,with any request made pursuant to this subdivision,or wi[hin five days of the date of the request,ezciuding Saturdays,Sundays and legal holidays,if immediau compliance is not possible. If he cannot comply with the request within that tune,he shall sa inform the individual,and may have an addiuonal five days within wluch 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 himself. To exercise this right,an individual shall nodfy in writing che responsible authoriry describing the nature of the disagreement. The responsible authority shall within 30 days either: (a)correct the data found to be inaccurau or incompleu and aaempt to nodfy past recipienu of inaccurate or incomplete data,including recipients named by the individual;or(b)notify die 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. Thp determinadon of the responsibte authority may be appealed pursuant to the provisions of the administradve procedure act relating to conusted 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 pemrit 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 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 t rocess thi�plication or permit. ��L Fi Middle � �t �� Address `�/ ` �/'(/, ��jfi� '7 7� �I ��" �. C---��O 'v� State Z�p Phone ry I understand my rights as stated above. , Signaare