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Sec.13.04 RICHTS OFSUBJECTS OFDATA Subdivision 1. Type ojdata The rights ojindrvidual on whom the data rs stored or to be stored shall be as set forth in thrs section. � Subd 2. Injormation required to be given ixdividuaL An individual asked 10 supply private or conf dential data concerning himself shall be informed of.• (a)the purpose and intended use of the requested data within the collectrng state agency,palitica[subdivision,or statywide system;(b)whether he may refuse or is legally reguired to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confrdential data;and(d)the identity of other persons or entities authorized by state or federal law to recerve the data. This requrrement shall not apply when an indivrdual is asked to supply investigative da�a,pursuant to section 13.82, subdivision 5, to a lmv enforcement o�cer. The commrssioner of revenue may place the notrce requrred under this subdivisron in the individual income tac or property tax retund instructions instead of on those forms. Subd.3. Access lo dala by individual. Upon request to a responsible authoriry,an individual shal!be informed whether he rs the subject of sJored data on individuals, and whether it is classrfied as public,private or confrdential. Upon his furthe�request,an individual who is the subject of stored prrvate or public data on rndrviduals shall be shown the data without any charge to hrm and, if he desrres,shall be injormed oj the cantent and meaning ojthat dala. Ajter an individual has been shotivn the private data and informed of its meaning, the data need not be disclosed to him for six months lhereafter unless a dispute or action pursuant lo this sectron is pending or additional data on the indivrdual has been collected or created. The responsible authorrry shall provide copies of the private or public data upon req:�est by the individua!subject of the data. The responsible authority may reguire the requestrng person to pay the actual costs of making,cert�ing,and compiling the copies. The responsible authorrry shall comply immediately,ijpossible,wrth any request made pursuant to thrs subdivrsion,or within five days of the date oJthe request,excluding Saturdays,Sundays and lega!ho/idays,if immediate compliance is not possrble. Ifhe cannot comply with the request wrthin that time,he shall so inform the indivrdual,and may have an additional frve days tivithin which to comply with the request,excluding Saturdays,Sundays and legal holidays. Subd.4. Procedure when data is not accurate or comp[ete.An indrvrdua!may contest the accuracy ar completeness ofpublrc or prrvate data concerning himselj. To exercise lhis rrght, an rndividua[shall not�rn wrrtrng the responsible authority describing the nature of the disagreement. The responsible authorrty shall within 30 days either: (aJ correct the dalafound to be inaccurate or incomplete and attemp!to not� past recrprents of inaccurate or rncomplete data,including reciprents named by the individual;or(b)not�ihe individual that he believes the data to be correct. Data in dispute sha[1 be disclosed only ijthe indivrdual's statement oJdrsagreement rs incfuded with the disclosed data. The determination ofthe responsible authority may be appealed pursuanl to the provisions ojthe administrative procedure act relating to contested cases. DATA PRIVACYADVISORY In accordance ivith M.S.13.04,Subd.2, 'Righls ofsubjects ofdata';we would like to inform you that your request for a permrt 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 wil!be used to determine your qualifrcation,jor the permit or license requested. 2. You may refuse 10 supply dala,but refusal may require that the Crty deny the permit or license. 3. The information may be shared ivith other/ocal,state or federal agencres to the extent necessary to process the permit or lrcense. 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(see folloiving page)to review private data on yourself. 6. Your full name is required to process this applrcation or permit. PLEASE PRINT _��r".;1�T,° -� ��G•C',�'�'!"<< �i � Frrst Middle Last i ,� . f-�� lC' i '�i ��'^--� �. -l�Y� .� /�� Address � a � f. % ' . _ ,; o; _ � ., , ,,; �i _ Ciry Stale Zip Phone I understand my rights as stated above. _ ��i�' � � i l // � e / r7 - . ,✓ L/�4f ' L� L�L^ �� Signature /0