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Sec.13.04 RIGHTS OF SUB.TECTS OF DAT� Subd. 1. Type of data. The righ[s of individual on whom the data is stored or co be scored shall be as set fonh in this secdon. Subd.2. Information reqirired to be given individual. Art 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 collecting"state agency,polidcal subdivision,or statewide system; (b)wherher he may refuse oY is legally required to supply the requested data:(c)any kaown consequence arising from his supplying or refusing to supply priva[e or confidential data;and(d)the identiN of ocher persons or enrides au[horized by state or fedecal law to receive the data. This requirement shall not apply when an individual is asked to supply invesdeadve data, pursuant ro secdon 13.82, subdivision 5, ro a law enforcement o�cer. The commissioner of re�enue mav place the norice reauired under this subdivision in the individual income tax or propertv tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible aurhority,an individual shall be informed whether he is rhe subject of scored data on individuals, and whether it is classified as public, private 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 wirhout any charge to him and, if he desires, shall be informed of the content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six monchs rhereafter unless a dispuce or acrion pursuan[to this secrion is pending or addidonal data on che individuai has been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the accual costs of making, cerafying; and compiling the copies. The responsible authoriry shatl comply immediately, 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 immediace compliance is not possible. If he cannot comply with the requesc within that time,he shali so inform the individual,and may have an addidonal five days wirhin which to comply with the request,excluding Sarurdays, 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 exetcise[his right,an individual shall noafy in wriang the responsible authoriry describing[he nature of the disagreement. The responsible authoriry shall wi[hin 30 days either. (a)correct the data found ro be inaccurate or incomplete and attempt to nodfy past recipiencs 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 determination of the responsib(e authoriry may be appealed pursuant to the provisions of the administrarive procedure act relacing to concested 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. ?, You may refuse to supply data, but refusal may require that the City deny the pemut or license. 3. T'he information may be shared with other local, state or federal agencies to the extent necessary to process the pernut or license. 4. If your requested pernut or license requires Council action to approve, some information may become public. �. 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. First Middle Lasc Address City State Zip Phone I understand my rights as stated above. Signature