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Sea 13.04 RIGATS O�'SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be soored s6all be as set forth in d�is section. �bd.2. Information required to be givea individual. An i�ividual asked to supply private or confidential data concerning himself shall be mfocaxd of: (a)the purpose and inunded use of the requesud data within the collecting state agency,poliucal subdivision,or stauwide system; (b) whether he may refuse or is legally cequired co supply the cequested data;(c)any Imown consequence arising from his supplying or refusing oo suPP�Y private or confidendal daa;and(d)the idenaty of other pecsons or enfiaes authorized by state or federal law ro ieceive the data. This requirement shall not apply when an individual is asked to supply investigative data,pursuant ro secaon 13.82,subdivision 5,ro a law enforcement officer. 'Il�e commissio�r of ievenue mav vlace the nodce ieauiisd under this�bdivision in the individual income taz or orooem taz refund insuuctions insuad of on those focros. Stibd.3. Ace�W data by mdividuai. Upon request W a responsible authority,an individua!shall be infocmed whether he is the subject of smced dara on individuals,a�whether it is ciass�ed as public,privam or confidendal. 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 conunt and meaning of that data. After an individuai has been shown the private data and informed of its meaning, the data need not be disclosed to him for siz months theceafkr unless a dispute or acaon pursuant to this section is pending or addiaonal data on the individuai has been collected or created. The responsible authoriry shall provide copies of the private or pubGc data upon request by the i�ividual su6ject of the data. T6e responsibie authority may require the requesdng person to pay the acriiai costs of making,certifying,aad compiling the copies. 1he cesponsble authority shall comply immediauly,if possible,with any cequest made pursuant w diis subdivision,or within five days of the daoe of the cequest,ezchiding Saaudays,S�ndays and legal holidays,if immediate compliance is not possible. If he cannot comply with the roquest within that time,he shall so infocm the individual,and may 6ave an additional five days within which ro comply with the isquest,ezcluding Saturdays,Sundays and legal holidays. S�bd.4. Procedure•whea daffi is not accurate or compl�e. An rodividual may�ontest the accutacy or completeness of public or private data conceming himcelf. To eae�cise this right,an individual shall notify in writing.the responsible authonry describing the nature of the disagreement The responsble authority shall within 30 days either. (a)corcect the data found w be inaccurate or incomplete and aaempt to noafy past recipients of inaccurate or incompleoe data,i�luding cecipienu named by the individual;or(b)nodfy the�individual'diat 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 deoerminaaon of the cesponsible authority may be appealed puisuant m the pmvisions of the administrative procedure act relating to contested cases. , _ , , DATA PRIVACY ADVISORY . In accordance with M:S. 13.04, S�ibd. 2, "Rights of subjects of data",'w� �4ould 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 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 shared with,other local, state or federal agencies to the eztent necessary to process the permit or license. 4. If your requested permit or license requires Council acrion to approve, some information may become public. 5. You have certaizt 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. ��UL C�cc V oG$.l.C-,�5�.6' First Middle Last �-('1C� CQ�'�•tC. c.a..w�a4 '�• Address `>2.0�� /'. s3-34� "�2�t i�,�— City State Zip Phone I understand my rights as stated above. Sig ture , 10