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Sec.13.04 RIGHTS OF SUB.TECTS OF DATA Subd. I. Type of data. The rights of individual on whom che 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 confidenrial data concerning himself shall be informed of: (a)the purpose and in[ended use of the requested data wichin the collecting"state agency,poliacal subdivision,or statewide system; (b)whether he may refuse or is legally required to supply the requested data:(c)any Irnown consequence arising fmm lus supplying or refusing to supply private or con6dential data;and(d)the idenriry of other persons or enndes authorized by state or federal law to receive the data. This requiremenc shall not apply when an individual is asked to supply invesrieadve dara, pursuan[to section 13.82, subdivision 5, ro a!aw enforcement o�cer. The commissioner of re�enue mav place the ❑odce reauired under this subdivision in the individual income tax or propem tax refund instructions instead of on those forms. Subd. 3. Access to data bv indi�ldual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of scored data on individuals,and whe[her it is classified as public, pnvate or confidendal. Upon his further request,an individual who is the subjecc 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 content and meaning of rhat data. Afrz�an individual has been shown the private data and informed of its meaning,the data need oot be disclosed to h¢n for six months thereafter unless a dispute or action pursuanc to chis secdon is pending or addidonal data on the individual has been collected or created. The responsible authoriry shall provide copies of the privace or public data upon request by the individual subject of the data. The responsible auchoriry may require the requesting person to pay the actual costs of making, cerufying, and compiling the copies. The responsible authoriry shall compiy immediately, if possible, wi[h any request made pursuant to this subdivision, or within five days of the date of[he request,excluding Sarurdays,Sundays and lega]holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform[he individual,and may have an addiaonal five days within 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 accuracy or completeness of public or pri�•ate data concerning himself. To exercise this right,an individual shall nodfy in writing[he responsible authority describing the nature of the disagreement. The responsible authoriry shall within 30 days either. (a)correct the data found ro be inaccurate or incomplete and attempt to norify 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. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The de[ermination of the responsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act relati�g 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 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 deterrnine your qualification for the pemut 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 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. j. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. (. Your full name is required to process this application or permit. �f �:,�/��/'� ,�, -�,;/„/' First Middle Last � � -� .�J' l�� ) �� Address ,. � , ' �' : ') ,� � � f`,�', /�',^� � • .. - � �`� %'/- �� ^ '�- � �' Ciry Stare Zip Phone I understand my,rights as stated above. � -- ---__.�__