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� f Sec.13A4 RIGHTS OF SUBJGCTS 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. Su6d.2. Information required to be given individual. An individual asked to supply private orconfidential data concerning himselfshall be infonned of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide systein;(b) whether he may refuse or is leeally required to supply the requested data;(c)airy kno�vn consequence arising from his supplying or refusin�to supply private or confidential data;and(d)the 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 investigati��e data,pursuant to section 13.32,subdivision�,to a law enforcement officer. The commissioner of revenue mav_place the notice required under this subdivision in the individual income ta�or propert��ta�refund instructions instead of on those forms. 3ubd.3. Access to data by individual. Upon request to a responsible audlority,an individual shali be infonned�vhether he is the subject of stored data on individuals,and whether it is classified as public,private or contidential. Upon his fuRher request,an individuaf who is the subject of srored private or public data on individuais shal I be shown the data evithout any charge to him and,if he desires,shal I be informed of the content and meaning of that data. After an individual has been shown the privafe data and infonned of its meaning,the data need not be disclosed to him for six months thereatter unless a dispute or action pursuant to this section is pending or additional dafa on the individual has been collected or created. The responsible authoriq�shafl 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 actual cos[s of making,certifying,and compiling the copies. The responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or�vithin ti�•e days of the date of the request,excluding Saturdays,Sundays and le�al holidays,if immediate compliance is not possible. 1f he cannot comply with the request within that time,he shall so infonn the individual,and may have an addi[ional tive days within whidl to comply with the request,ezcludine Sacurd�ys, SunJays and legal liolidays. Subd.4. Procedure when data is not accurate or complete. An indiv idual may contest the accuracy or complefeness of publ ic or private data concerning himself. To e�ercise this ri�ht,an individual shall notify in w�riting the responsible authority describing the native ofthe disagreement. Tlie responsible authority shall 4vithin 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete dat�,including recipients named by the individual;or(b)notify the individual that he believes fhe data ro be correct. Data in dispute shall be disdosed only if the individual's statement of disa�reement 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 contested cases. DATA PRIVACY r�DVISORY In accordance with M.S. 13.04,Subd.2,"Rights of subjects of data",we would lilce to infonn you that your request for a pennit 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 fw•nish will be used to determine your qualification for the permit or license requested. 2. You may refuse to supply data,b�rt 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. [f your requested permit or license requires Council action to approve, some information may become public. �. You have certain cights under M.S. 13A�4 (available upon request)to review private data on yourself, 6. F Your full name is rec�uired to process this app(ication or permit.g l/�'G�d'��vl �✓.t �' � �a✓�ll�'��' First �[iddlc / Last ��..� (J ��y�� 1,� �� J��`aJ Address �� y��V'(�� "� .�� ' �.J��-��lz� `GC,Oi� Cit� State Zip Phonc I und rst�nd m � ri�hts �s stated ab ve � � � �� ,� / ,(%' � ' ,/� '�.� � Si�naturc ,/� , !Lr Reset Form =?