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Sec.13.04 RIGHTS OF SLTB.TECTS OF DATA Subd. 1. Type of data. 'Ihe righrs of individual on whom the data is stored or to be stored shall be as set for[h in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal data concerning himself shall be informed of: (a)tho purpose and incended use of the requesced data within the collecring'srate agency,polidcal subdivision,or statewide symm: (b)whe[her he may refuse or is legally required to supply the Rquested data;(c)any known coasequence arising from his supplying or refusing to suppiy private or confidenaal data:and(d)the identiry of otber persons or entiries authorized by state or federal law to receive the data. This requutment shaii noc apply when an individual is asked to supply investigaave dara, pucsuant to secaon 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav place the noace required under this subdivision in the individual income ta�c or Drocem raz refund instrucrions instead of on those forms. Subd. 3. Access to data by indiridual. Upon request to a responsible authoriry,an individual shall be informed whether he is[he subject of stored data on individuals, and whether i[is classified as public, private or confidenaal. Upon his further request,an individual who is the subject of stored private or public dara on individuals shall be shown the data wi[hout any charge to him and,'if he desires, shall be informed of the content and meaning of that dara. After an individual has been shown the priva[e data and informed of its meaning, the data need not be disclosed to him for six months the.eaft::r unless u dispute ur�ic.;�r+Yursuaru:e :::is seccor.is per_din3 or additio�al data a:rhe individual has been collected or crea[ed. The responsible authoriry shall provide copies of the priva[e or public data upon request by the individual subject of the data. The responsible au[horiry may require the requesting person ro pay the actual costs of making, cerdfying, and compiling Ihe copies. The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision, or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is no[possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addiaonal five days wi[hin 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 accuncy or completeness of public or private data concerning himself. To exercise this right,an individual shall no[ify in wriring the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days eirher. (a)correct the data found ro be inaccurate or incompiete and attempt to nodfy past recipients of inaccurate or incomplete data, including recipients named by[he individual; or(b) nocify the individuai that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statemen[of disagreement is included with the disclosed data. The determination of[he responsible authoriry may be appealed pursuant to the provisions of the adminisaadve pcocedure act relating co conrested 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 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 fumish 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 ma.y 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 da[a on yourself. (, Your full name is required [o process this application or permit. � First Middle ' / Lasc � vE Address � / �S?/ � �O /1( J �P - C�ry State Zip Phone I understand my rights as stated above. �• ig re