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, � i Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. "fhe rights of individual on whom the data is stored or to be stored shall be as set fo�th in this section. Subd.2. Infonnation required to be given individuaL An individual asked to supp]y piivate or confidential data conceming himself shall be infonned of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b) whether he may refuse or is legally required to supply the requested data;(c)any known consequence arisin�from his supplying or refusing to supply private or confidential da[a;and(d)the identity of other persons or entities authorized by state or federal law to receive the data. This requirement shall not appiy when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue mav place the notice required under this subdivision in the individual income tax or propeRv tax refund ins[ructions instead of on those fonns. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be infonned whether he is the subject of stored data on individuals,and whether it is classitied as public,private or confidentiaL Upon his furthcr request,an individual who is the subject of stored private or public data on individuafs shall be shown the data without any charge to him and,if he desires,shall be inFonned of the content and meaning of that data. After an individual has been shown the private data and infonned of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsibte authority shall provide copies of the p�ivate or public data upon request by the individual subject of the data. The responsible authonty may require the requestin�person to pay the actual costs of making,certifying,and compiling dte copies. The responsible authority shall comply immediately,if possible,wi[h any request made pursuant to this subdivision,or within five days of the date of the request,excluding Satw�days,Sundays and Iegal holidays,if immediate compliance is not possible. [f he cannot comply with the request within that time,he shall so infonn the individual,and may have an additional tive 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 piivate d�G1 conce�ning himself. To exe�-cise this iight,an individual shal(notify in writing[he responsible authority describing the nature oFthe disagreement. The responsible authority shall within 30 days either. (a)con�ect the data found to be inaccutate or incomplete and attempt to notify past recipients oF inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be con�ect. Data in dispute shall be disdosed only if the individual's statement of disa��eement is included with the disclosed data. The detennination of the responsible authority may be appealed pursuant to the provisions of the administ�ative 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 infocm you that your request for a pernlit 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 detennine 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 pennit. � ; :-S��✓��/� S-, ��'1� �-✓'f� % Firsf Middlc Last //c/ S` �r/✓�v 1 j� �r/, � Address ��..�� .��,� �-v s s�s�� Citv Statc Zip �honc I under�nd my riahts as stated above. — � � � .- � (�- Signature