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� . . Sec13.04 RIGHTS OF SUBJECTS OF DATA Subd. t. Type of data. The rights of individual on whom the data is stored or to be stored shail be as set forth in this section. Subd.2. tnformation required to be given individual. An individual azked to supply private or confidential data concerning himself shall be informed oE (a)the purpose and intended use of the requested data within the collecting state agency,po(itical 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 contidential data;and(d)the identity of other persons or entities authorized by state or federat la�v to receive the data. 'Chis requirement shal l not apply when an individual is asked to supply investigative data,pursuant to section 13.32,subdivision 5,to a fa�v enforcement officer. 'I'he commissioner of revenue mav place the notice reauired under this suUdivision in the individual income tax or orooertv tax refund instructions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible auihority,an individual shall be infoRned whe[Izer he is the subject of stored data on individuals,and whether it is classified as public,private or confidential. Upon his fuRher request,an individual wha is the subject of stored private or public data on individuals sllall be shown the data without any charge to him and,if he desires,sliall be informed of the content and meaning of thac data. After an individual has been shown the private data and infonned of its meaning,�he data need not be disctosed to him for six months thereafter unless a dispute or action pursuant to this sec[ion is pending or additional data on the individual has been collected or created. The responsible authority shall provide copies of[he private or public data upon request by tlle individual suUject of tlte data. The responsible authoriry may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,orwithin five days ofthe date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. if he cannot comply with the request within that time,he shall so infortn the individual,and may have an additional five days wichin 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 writin;the responsible authoriry describing the nature of the disagreement. The respo�sible authority shall within 30 days either: (a)coRect the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,including recipiencs named by the individual;or(b)notify 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 detecmination of the responsible authority 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 pernrit or license from the City of Orono or any of its departments may require you to fizrnish certain private or confidential infocmation. You are notified that: 1. The information you furnish will be used to detemzine your qualification for the pernvt or license requested. 2. You may refuse to supply data,but refusal may require that the City deny the pemut or license. 3. The informarion may be shared 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. Eirst Middle Lust Address City State Zip Phone I understand my rights as stated above. . � Signature 10