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�r� Y Sec.13.04 RIGHTS OF SCTBJECTS 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 data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting§rate agency,polidcal 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 confidential data;and(d)the idenriry of other persons or entides authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigadve data, pursuant to secdon 13.82,subdivision 5, to a law enforcement o�cer. The commissioner of revenue mav alace the notice requirod under this subdivision in the individual income taz or propertv t� refund insuucdons instead of on those forms. Subd. 3. Access to data by individuaL YJpon request to a responsible authority,an individual shall be infortned whether 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 who 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 informed 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 disciosed to him for s'vc months thereafter unless a dispute or acdon pursuant to this secrion is pending or additional data on tt►e 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 authoriry may require the requesting person to pay the actual cosu of making,certifying,and compiling the copies. . The responsible authority shall�comply immediately,if possible,with any request made pursirant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if icnmediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addiaonal five 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 private data conceming himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement. The responsible authoriry shall within'30 days bither: (a)correct the data found to be inaccurate or incoit►plete and aaempt to nodfy past recipients of inaccurate or incomplete data, including recipients named by the individual;or(b)noafy the 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. The determination of the responsible authority may be appealed pursuant to the provisions of the administradve 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 permit 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 fumish 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 Ciry 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 pemut 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. GW'VI �• �V'1�l�Q�V1 First Middle Last �� • � g� Address _1�1 pa rad� p(�� M� .��3�'-.�i 4��t-�k�c� City Srate Zip Phone I understand my rights as stated above. ` I�,."��I�V1.1.GC/t,�Jnm.,_�--- - Signature