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Sec.13.04 RIGHTS OF SUt3JGCT5 OF DATA Subcl. I. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set foiih in thi�sectio�l. Subd.2. Infonn��tion required to be given individual. An individual asked to supply private or confidential data concerning himself shall be infonned of: (a)the purpose and intended use of the requested data within the coltecl.in�stal:e agency,political subdivision,or sta[ewide system;(b) whether he may refuse or is legally required to supply the requested data;(c)any known conseyuence arising Gom his supplying or reiusing to supply private or confidential data;and(d)the identity ofother persons or entities au�horiz,ed by state or federal law to receive the da[a. Tl�is requirc;menc shall not apply when an individual is asked to supply invesli��tive data,pw�suant to section 13.82,sub8ivisivn 5,ro a law enforcement oCficer. The commissioner of revenue ma�place the notiee reguired under Niis subdryision in tlie inclivicival income tax or prooerty tax refund instructions instead of on those fonns. Subd.3. Access to data by individuaL Upon requesC to a responsible authority,an individual shall be i�fa�med whether he is the subject of slorcd data on individuals,and whether it is classified as public,private or con[idential. Upon}iis(urtl�er request,an individual who is Ihe subjcct of sfored pri��ate or puUlic data on individuals shall be sho�m the data without any charge to him and,if he desires,shall be inti>nned of the content and meaning of that data. Aftcr an individual has been shrnvn the private dala and inforrned oY iYs meaning,the data taeed not be disclosed to him fur six months thereafter unless a dispute or action pursuant lo tliis section is pending rn additiooat data on the inclividual l��s been collcctcd or created. The responsible authority shall provide copies of the private or puUlic data upon request by the individual subject of the data The responsible authority may require the requesting person to pay lhe actual costs of making,ceitifying,and compiling tlie copies. The responsible au(hoiity shall comply immediately,if possiUle,witl��ny request made pursuant to this subdivision,or within five days of the da[e of�the request,excluding Salurdays,Sundays and legal holidays,if immediale compliancc is not possiblc;. if he cannot eom��ly��iLh the request wilhin that time,he shall so infonn lhe individual,and may have an additional lrve days�vithin which to comply with die request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when daCa is not accwate or cotnplete. An individual may eontest the accuracy or completeness of publie or priv�te d�ta concerning himselE To exercise this right,an individua(shall notify in writing tiie responsib(e authori.ry describing the nafure of ll�c disa��eemcnt. The responsible auUiority shall within 30 days either: (a)con�ect the data foun�l to be inaceurale or incoiuplete a��d�ttempt to notify past recipients of inaccurate or incompiete data,including reeipients named by the individual;or(b)notify the individual that he believes the data ko be con�ect. Data in dispute shall bc disdosed only if lhe individual's st��tement of disagreement is induded with the disclosed data. Tlie detennination of lhe responsible aulhority m1y be appealed puisuant to(he provisions of the administrative procedure�ct relating to contested cases. naT�ruzv�.cx Ewvisox� In accordance with M.S. 13.04,Subd.2,"Rights of subjec[s o�f data",we would like to inform you that your request for a pennit or license from the City of Orono or any of ils departtne��ls may require you to furni5li cei tai,i private or confidential inforivation. You are notified that: 1. Tlie infonnation you furnish will be used to detennine yal�ir qualification for the pennit oc lice�nse requested. 2. You may refuse to supply data,but refiisal inay rec�uii•e t1�at tlie City deny tlie pennit or license. 3. The infoin�ation may be shared with other local, state� or faderai agencies to the extent necessary to � process tl�e pennit or license. 4. If your requested pei-�nit or license requu�es Council action to approve, son.le infonziatioi�i inay bccome public. 5. You have certain rights under M.S. 13.04 (ava�il�ble upon z•eqi�iest)to review private d�ta on yourself. � 6. Y ur full name is required to process this a��plication or perrnit. �� ��rsc n-��di� � -- -- -- -- — a,zse ��__� �� c,�,.� � Address —t�--�� C�------..�--- --- ��.7"�"� � �� �--�= ��+/----- -�� - �'�-��'�. City �j� Statc_ �6�� 'hone r'"� � - -. I understand my ri� s as s � o� . ``�� --�' ,; .--_�' � : �____ Signature ------ — �l'--+ . ;�