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� r Z t' Sec.13.04 RIGHTS OF S[JBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this secaon. Subd.2. Information reqtrired to be given individual. An individual asked ro supply private or confidenrial data concerning himself shall be informed of: (a)the purpose and iatended use of the requesced data within the collecdng'state agency,polirical subdivision,or sratewide system; (b)whether he may refuse or is legally required ro supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidential data;and(d)the identiry of other persons or enddes authorized by state or fedecal law to receive the data. T'his requirement shall not apply when an individual is asked to supply invesdearive data, pursuant to section 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of re�enue mav place the ❑otice reauired under this subdivision in the individual income tax oc properN tax refund instructions instead of on those forms. Subd. 3. Access to data by indiridual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals, and whe�her it is classified as public, private or confidenaal. Upon his further request, an individual who is the subject of stored private or public data on individuals shall be shown[he data wichout any charge to hun and, if he desires, shall be informed of the conten[ 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 months thereafter unless a dispute or acrion pursuant to this secdon is pending or addidonal data on the individual has been collected or crea[ed. The responsible authoriry shall provide copies of the private or pubiic data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual costs of making, certifying,and compiling the copies. The responsible auchoriry shal(comply immediately, if possible, with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and leeal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,excluding Saturdays, 5undays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data conceming himself. To exercise[his rieht,an individual shall norify in writing the responsible authoriry describing the nature of[he disagreement. The responsible authoricy shall within 30 days either. (a)correct the data found ro be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data, inciuding 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 de[erminarion of the responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act reladng 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 fumish certain private or confidential information. You are notified that: 1. T'he 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 shared 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 pemut. �� i � � j�J -�iL S �(� �r'�. �'/L-� First M dle � Last � � � �� ,0 , �__�-._-( Address�j � �� i`� J �J �, ' � � �.�� C�ty State \ Zip Phone i I u rstai� my ri as ated abqve. � � �v . Signature