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: . Sec.13.04 RIGHTS OF SLTBJECTS OF DATa Subd. 1. Type of data. The righcs of individual on whom�he dara is swrrl or co be scorod shall be as set forth in this secaon. Subd.2. Information reqirired to be given individual. An icdividual asktd w supply private or confidenrial data concerning himself shall be informed of: (a)the purpose and iacended use of the requesred data wi�in the collecang Etate agency,poliacal subdivision,or statewiCe rysum; (b)whecher he may refuse oY is legally required co supply the requesud daa:(c)any lmown coasequence arising from his supplying or refusing to supply privace or conndenaal data;and(d)the idendry of o�her persoas or endaes auchorized by state or federel law to receive the data..'Ihis requirement shail not apply whan an individual is asked to supply invesdgadve data,pursu�c co secdoa 13.82,subdivision 5,[o a law enforcemenc o�cer. 'Ihe commissioner of re�enue mav place the nodce rewired ender this subdivision in the individual income tax or prooerrv taz refund instructions inscead of on chose forms. Subd.3. Access to data by iadividual. Upon rcquest to a responsible aarhoriry,an individual shall be informed wherher he is the subject of stored data on individuals,and whecher it is classified as public,priva`or conftdenrial. Upon his further request,an individual who is[he subjecc of scored private or public daea on individuals shall be shown[he dara wi�ou[any c'n��e to him and;if he desires,shall be informed of[he concent and meaning of[hat data. After an individual has been shown the privar�daca and in:ormed of ics meaning,che daca need not be disclosed ro him for six months ehereafter unless a dispute or acdon pursuanc to �his secdon is pending or addiaonal data on the individual has been collected or created. The responsible auchoriry shall provide copies of the private or public data npon reques:by the iadividual subject of the data. The responsible authoriry may require the requesting person ro pay che actual costs of making,cerying,and compiling the copies. The responsible auchoriry shall comply immediately,if possible,wich any r.quest made pursuant to this subdivision,or within five days of the da[�of the nquesc,exciuding Saeurdays,Sundays and legal holidays,if immediace compliance is not possible. If he cannot comply wirh th�request wichin thac dme,he shall so inform�he individual,and may have an addidonal five days wiehin which to compiy wi�h the request,excluding Satucdays, Sundays and legal holidays. Subd.4. Procedure whea data is not accurate or complete. An individual may concest the accuracy or completeness of pubiic or private dara concerning himsetf. To exercise[his righc,an individual shail norify ia wridng�e responsible authoriry describing ehe naare of the disagreemenc. The responsible auchoriry shall within 30 days either: (a)correct the daa fcund to be inaccurate or incomp[ece and aaempt to nodfy past�scipiencs of inaccurate or incomplete data, including recipiencs named by the individ�:ai:or(b)�oafy the individual thac he believes the daca to be cocrecc. Data in dispu�e shall be disclosed only if the individual's sta�emenc of disagree�=nc is ir.cluded wi[h[he disclosed data. , The decerminadon of the rasponsible au�horiry may be appeal:3 pursuanc to the provisions of che admuusaarive procedure act r.laang to concested cases. . DATA PRIV�CY ADVISORY In accordance with M.S. 13.04, Subd.2, "Rights of subjects ot data", we would like to inform you that your reauest for a permit or license from the City of Orono or any of iu deparments may require you to furnish certain privace or confidential information. You are notified that: 1, The information you furnish will be used to de:ermine�•our qualification for the permit or license requested. 2. You may refuse to supply data, but refusal may require that the Ciry deny the permit or license. 3, The information may be shued wi[h other loc�l, state or federal agencies to the extent necessary ta process the permit or license. 4. If your requested perm.it or license requires Council action to approve, some information may become . . public. j, 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 aoplication or permic. Fitst Middle Last Address • Ciry State Zip Phone I understand my ri�hts as stated above. /'� Signature