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Sec.13.04 RIGHTS OF SLTBJECTS OF DATA Subd. 1. Type of data. The rights of iniividual on whom rhe data is stored or to be stored shall be as set forth in flvs section. Subd_2, Infurm�reqitired to be given mdividual. An individual asked to supply private or confidential data conceming himself shall be informed of: (a)the purpose and inte�ed use of the requested data within the collecting state agency,polidcal subdivision,or statewide system;(b)whether he may refuse or is legally required to supply the requested data;(c)any lrnown conseque�e arising from his supplying or refusing to supply private or co�t"idential data;and(d)the identity of other persons or enaties authorized by srate or federal law to receive the data. 'Chis requirement shall not apply when an individual is asked to supply invesdgadve data,pursuant to section 13.82, subdivision 5,to a law enforcement officer. The commissioner of revern�e mav olace the notice rewired under this subdivision in the individual income taz or nrocertv taz refund incrructions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the svbject of stored data on individuals,and whether it is classified as public,private or confidential. Upon his further request,an ic►dividual who is the subject of stored private or pubiic data on i�iividuals 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 infocmed of its meaning,the data need not be disclosed to him for six monthc thereafter unless a dispute or action pursuant to d►is secdon is pei►ding or addidonal data on the individual has been collected or created. The respoosible aut6ority shall pmvide 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 pursuant to this subdivision,or within five days of the date of the request,ezcluding Saturdays,Sundays acui legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that dme,he shall so inform the individual,and may have an additiona!five days within wluch to comply with the request, excluding Saturdays,Sundays and legal holidays. Slibd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data co�eming himsel£ To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. The responsible awhority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete a�attempt to nodfy past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data w 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 authoriry may be appealed pursuant to the provisions of the administrative 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�iry 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 shazed 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 fu11 name is required to process this application or permit. �an C�^ea r First Middle Last ��U SPRT� S ��e. Address� � � /O/� �'HS H �1'I� S �/ " 7� - City State Zip Phone I understand my rights as stated above. ,�G� CrYa� s;gnaaue / _ �.�dk �i�•v ��/ 6