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Scc.13.04 RIGHTS OF SUBJECTS OF DATA Subd. L Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Information required to be given individual. An individual asked to supply private or contidential dataconceming himselfshall be infonned of: (a)the purpose and intended use of die requested data witliin the collecting 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 reflising to supply private or confidential data;and(d)d�e identity ofother persons or entities authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a la��enforcement officer. The commissioner of revenue maXplace the notice required under this subdivision in the individual income tax or�ro�ertv tax refund instructions instead of on those fonns. Subd.3. Access to data by individual. Upon requestto a responsible authority,an individuai shall be informed whether he is the subject of stored data on individuals,and whether it is ciassitied as public,private or contidential. Upon his further request,an individual�vlio 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 ofthe content and meaning of that da[a. After an individual has been shown the private data and informed of its meaning,the data need not be disdosed to him for six months thereafter iniless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible audiority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible audiority may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,orwidiin tive days of the date ofthe request,excluding Sa[urdays,Sundays and legal holidays,if immediate compliance is not possible. Ifhe cannot comply with the request within that time,he shall so inform the individual,and may have an additional tive days within which to comply with the request,escluding Saturdays, Sundays and legal holidays. S ubd.4. Procedure�vhen data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shall notiiy in writing the responsible authority describing the na[ure of[he disagreement The responsible authority shall within 30 days either. (a)correct the data tbund to be inaccurate or incomplete and attemp�to notif'y past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Daca in dispute shall be disclosed only ifthe individual's statement ot disagreeinent 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 contes[ed 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 furnish will be used to deterniine 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. Tlle information may be shared 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 pubiic. 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. �Av� � C��,�.rA� ��i p S First N[iddlc Last a �� 3 � �;.��,�� r��,� . Address f� C��.�/�►� ��l � �3?/ �� Z — ��—�' 3v o Citv Sh�tc 7ip Phone I under�tand y rights as s ted above. ,___ ' � � � Si�naturc Reset Form ��