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i 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 secrion. Subd.2. Information required to be given individual. M'u�di��idual uked to suppl}•private or co�dendal data concerning himself shall be informed of: (a)the purpose and inte�ded use of the requested data within the colleccin¢state agency,political 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 confidential data;and(d)the identity of other persons or enriries authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply im�estigati�•e data, pursuan[to section 13.82, subdivision 5, to a taw enforcement o�cer. The commissioner of revenue mav olace the norice reauired under this subdivision in the individual income tax or nrocertv tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upoe request to a resporisible authoriry,amindividual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or confidendal. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown thz 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 show�n the pri��ate data and informed of its meaning,the data need not be , disclosed tn him for six months thereafter unless a disputg oc aepon pursuant co this secrioA is pending or additional da[a on[he individual has been collected or created. The responsible authoriry shall provide copies of the pri�ate or piiblic data upon request by the individual subject of the data. The responsible auttiarriry may require the requesting person to pay the actu�l costs of making,certifying,and compiling the copies. ' The responsible suthoriry shall comply immediately,if possible,u idt any.iequest made•pursuant to this subdivision,or within five days bf the date of the request,excluding Satu�days,Sundays and legal holidays.if immediate comp[iance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may ha�•e an addidonal five days within which to comply with the request, excluding Saturdays,Sundays and legal holidays. Subd.4. Prceedure when data is not accurate'or complete, �,an individual t�ay contest th�accaracy or completeness of public or priva0e data concernin�himself. To exercise this right,an individual shall notify in wriring the Eesponsible authoriry describing the naNre of the disagreeme�. The responsible authoriry shall witt►in 30 days either. (a)correct dte dara found m be inaccurate or incomplete and attempt to notify past recipients of inaccurdte,or u�compleoe d�ta,including recipien[s named b�-the indi�idual;or(b)notify the individual ihat he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreemtnt is included with the disclosed data. The determination 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 permit or license from the Ciry of Orono or anv of its departments may require you to furnish certain private or confidential information. You are notified that: 1. The information you fumish will be used to determine your qualification for the permit or license requested. 2. You may refuse t�q supply data, �ut refusal may require that the City deny the permit or license. 3. The information may be sh�red wittr 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 permit. /��fz�/� [��!�C��l�� .��i First Middle Last �d4/ /�i'.5�� -- Addre . I .eG� �//�Ls� �.�-�- S3�� 3��7�� i State Zip Phone I understand my rights as stated above: • .�i�li��'��/ .�i�� - Signature 6