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x Sec.13.04 RIGHTS OF SUBdECTS 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 secflon. Subd.2. Informatioa reqirired to be givea individual. An individual asked to supply private or confidendal data concerning himself shall be informed of: (a)the purpose and incended use of the requesud data within the collecting state agency,polidcal subdivision,or statewide rystem;(b)whecher he may refuse or is legally required to supply the requested data;(c)any laiown consequence arising from his supplying or refusing ro supply private or confidentia!data;and(d)the idenary of other persons or enddes authorized by srate or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigaave data,pursuant to seccion 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav olace the notice reauired under this�ibdivision in the individual income taz or orocertv tax refund instructions mstead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stared data on i�ividuals,and whether it is classified as public,private or confidential. Upon his further request,an uidividual 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 rhe content and meanin�of that data. After an individual has been shown the private dara and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispure or acaon pursuant to this secaon is pending or addidona!data on the individual has been coUected or created. The responsible authoriry shap provide copies of the private or public dara upon request by the individual subject of the data. The responsible authority may require the requesting person W pay the actual cosu of making,certifying,and compiling the copies. The resporuible authoriry shall comply immediately,if possibte,with any request made pursuant to this subdivision,or within five days of rhe date of the request,ezcluding Saturdays,Sundays and tegal holidays,if immediate compliance is not possible. If he cannot comply with the request wi[hin that time,he shall so inform the individual,and may have an addiaonal five days within which to comply with the request, excluding Samrdays,Sundays and legal holidays. Subd.4. Procedure when data is aot accurate or complete. An individual may contest the accuracy or completeness of public or private data conceming himself. To exereise this right,an individual shall notify in wriang the responsible authoriry describiwg the nature of the disagreement. The responsible authoriry shall within 30 days eithe�: (a)correct the data foucxi w be inaccurate or incomplete and aaempt to noafy past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)nodfy 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 disciosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the administradve procedure act relating to contested cases. DATA PRIVACY ADVI ORY 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 aze notified that: � i. 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 full name is required to process this application or pemut. 5-4-�trt.L. To��n �-c' �e✓ F�r.�c, M�ddle Last /�—" �—�� ('P,I�G �r��rr Address �J 5533► �-z ��ry' Srate Zip Phone I understand y ri stated ove. Signature , 6 - •