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Sec.13.04 RIGHTS OF S[JBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Information required to be given individual. An individual asked to supply private or confidendal dara concerning hiroself shall be infomxd 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 arising from his supplying or refusing to supply private or confidendal data;and(d)the idendry of other persons or enddes authorized by state or federal law to receive d�e dare. This requirement shall not appiy when an individual is asked to supply invesdgative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. 'Ihe commissiorer of tevernre mav alace the notice reauired under this subdivision in the individual income tax or orooem tax refund insm►ctions instead of on those forms. Slibd.3. Access to data by mdividual. Upon request to a responsible authority,an individual shall be informed R•hether he is the subject of stored data on individuals,and whether it is classified as public,private or confidential. Upon his further request,an individual R•ho is the subject of stored private or public data on individuals shall be shown the data without any charge to him and,if he desires,shall be infocmed of the content and meaning of that data. After an individual has been shown the private data and informed of iu meaning,the data need not be diulosed to him for six months theceafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authority shall pmvide copies of d�e private or public data upon request by the individual subject of the data. The rosponsible authority may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The�esponsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision.or within five days of the date of the�est,ezclud'mg Saau�days,S�adays azd legal holidays, if immediate compliance is not possible. If he cannot comply with the request within that dr�,he shall so infocm the individual,and may have an additional five days within which to comply with the request,ezcluding Satuidays,Sundays and legal holidays. Subd.4. Procedure when data ic not accurate or compl�e. An indiv�ual may contest the accuracy or completeness of public or private data co�eming himself. To ezercise this right,an individual shall nodfy in writing the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days eidier: (a)cornct the data found to be inaccurate or incomplete and aaempt to notify past recipients of inaccurate or incompleo�data,i�luding recipienu named by the individual;or(b)nodfy the individual that he believes the data to be corcect. Dare in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant ro the provisions of the administrative pmcedure 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 permit 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 fumish 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 shazed with other local, state or federal agencies to the extent necessary to process the pemut 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. � � �� .c�� First_` ry ��S r..� �� idd I.ast 7c� AddreV�� /�—P �� "'`f✓�� lo� �l�� P'�cJ ! � Ciry� State Zip Phone I understand my right state . Si ture 10