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l � . � Sec.13.04 RIGI�TS OF SUBJECTS OF DaT� Subd. i. Type of data. The righrs of individual on whom the data is stored or to be scored shall be as set forth in this secaon. Subd.2. Information required to be given individual. .\n individual asked to suppty private or confidenrial data concerning himself shall be informed of: (a)the purpose and incended use of the requested data within the collecring"state agency, polidcal subdivision,or sratewide system; (b)whether he may refuse oY is legally required to supply tbe requested data;(c)any known coasequence arising from his supplying or refusing to supply private or confidennai data;and(d)the idenriry of ocher penons or enrides auchorized by state or federal law to receive the data. This requirement shall not appty when an individual is asked to supply investieadve dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement ofFicer. The commissioner of re�enue mav place che nodce reauired under this subdivision in the individual income tax or propercv tax refund instruc[ions instexd of on those forms. Subd. 3. Access to data by indi�-idual. Upon requesc to a responsible authority,an individual shall be informed whether he is the subjecc of stored data on individuals,and whe[her it is classified as public, private or confidenaai. Upon his further request, an individual who is the subject of stored private or public data on individuals shall be shown[he data without any charge ro hun and, if he desires, shall be informed of the content and meaning of that data. After an individual has been shown the privace data and informed of its meaning, che data need no[be disclosed to him for six months therea[ter unless a dispute or acrion pursuan[to this secdon is pending or additional data on the individual has been collected or crea[ed. The responsibie authoriry sha(!provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the acnial costs of making, certifying, and compiling the copies. The responsible authoriry shall comply immediately, if possible, wich any request made pursuant to this subdivision, or within five days of the date of the request,exctuding Samrdays,Sundays and leeal holidays,if immedia[e compliance is not possible. If he cannot comply wi[h the request within that time,he shall so inform the 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 pubiic or pri�•ate data concerning himself. To exercise rhis rieht,an individual shall notify in wridng the responsible authoricy descnbing che nature of the disagreement. The responsible authoriry shall within 30 days either. (a)correc[rhe data found ro be inaccurate or incomplete and attempt to nodfy past recipien[s of inaccurate or incomplete data, inciuding recipients named by the individual; or(b)notify the individual[ha[he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with[he disclosed data. The de[erminacion of the responsible au[horiry may be appealed pursuant to the provisions of the administrarive procedure act relating 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 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 pemut or license. 3. The information may be shazed with other local, state or federal agencies to the extent necessary to process the pernut or license. 4. If your requested permit or license requires Council action to approve, some information may become public. 5, 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. �r�) 1--�<_ zl�� v�1� First �fiddle Last �� \�� 'k � � � Add�ss �� 1 ��V �� i�j{� . ! 1�{ !�[ t1'l �(C �� — Ciry Stare Z�p Phone I understand my rights as stated above. C R, Signa re