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� Sec.13.04 RIGHTS OF SLJB.TECTS OF DaTA Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. ,4n individual asked to supply private or confidendal data concerning himself shall be informed of: (a) the purpose and intended use of the requested data within the collecRng'sta[e agency, polidcal subdivision,or statewide rystem; (b)whether he may refuse or is legally required co supply the requesced data;(c)any F�own consequence arising fmm his supplying or refusing to supply • priva[e or confidendal data;and(d)[he idenary of other persoas or enades authorized by state or federal law to receive the data. This requiremenc shall noc apply when an individual is asked to supply invesrieadve dara, pursuanc to secaon 13.82, subdivision 5, to a law enforcement ofFicer. - The commissioner of revenue mav pface che noace reauired under this subdivision in the individual income tax or propettv tax refund instruccions insLead of on[hose forms. Subd. 3. Access to data by individual. 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, private or confidendal. Upon his furtber request,an individual who is the subjecc of stored private or public data on individuals shall be stiown che daca wichout any charge to him and, if he des'ues, shall be informed of the conten[ and meaning of�hat dara. After an individual has been shown tbe priva�e data and informed of its meaning, che data need not be disclosed to him for six mon[hs thereafter uriless a dispute or acdon pursuant to this secdon is pending or addiaonal data on the individuai has been collected or created. The responsible authoriry shall provide copies of the private or public data upon requesc by the individual subject of the data. The responsible authoriry may require the requesting person to pay the ac[ual costs of making, cerafying, and compiling the copies. The responsible authoriry shall comply immediace(y, if possible, with any request made pursuant to this subdivision,or within five days of the date of the request,exciuding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individuai,and may have an addidonal five days within which to comply wich 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 chis right,an individual shall nodfy in wridng the responsible au[hority describing[he nature of the disagreement. The responsible auchoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of inaccurate or incomplete data, inciuding recipients named by the individual; or(b) nodfy the individual tha[he believes rhe data to be correct. Data in dispute shall be disclosed only if the individual's statemen[of disagreement is included with[he disclosed data. The determinaaon of the responsible auchoriry may be appealed pursuant to the provisions of the administrarive procedure act relarin, to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Ri�hts of subjects of data", we would like to inform you that your request for a permi[ or license from the Ciry 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 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 perm.it 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. 5. You have certain ri�hts under M.S. 13.04 (availabie upon request) to review private data on yourself. 6. Your full name is required to process this application or permit. ' � � G �� / irst vtiddle Last �� i �' �/f/ft�� /�.d �� , /�1��(/ /4"l�� ✓ �3 5 � � � ��.�,��_�Z City State Zip Phone I understand my ri?hts as stated above. � S acure