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Sec.13.04 RIGHTS OF SLJBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the dara is stored or m be stored shall be as set forth in this section. Subd.2. Information required to be given individual. An individual asked tn sapply private or confidenrial data conceming himself shall be informed of: (a)the purpose and intended use of the requested data within the collecring state agency, polidcal subdivision,or statewide system; (b) whether he may refuse or is legally required to 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 entiaes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data, pursuant to s�:crion 13.82, sabdivisio�5, to a law enforcement officer. The commissioner o�'revenue mav place rhe noace required under dus�tdivision 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 authority, an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or wnfidential. Upon his further request, an individual who is the subject of stored private or public data on individuals shall be shown the data without any charge co him and, �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 iu meaning, the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual•k�es been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the d�ta. The responsible authoriry may require the requesting person to pay the actual cosu of making, certifying, and compiling t�e copies. The responsible authority shall comply immediately, if possible, with any request made pursuant to this subdivision, or wi[hin five days of the date of the request,exduding Sanudays,S�ndays and legal 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 addidonal 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. M individual may contEst the accucacy or completeness of public or private data conceming himself. To exercise this righ[, an individual shall noafy in writing[he responsible authority describing the nature of the disagreement. The �esponsible authoriry shall within 30 days either. (a)correct die data found to be inaccucate or incomplete and attempt to nodfy past recipienu 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 individuaPs statement of disagreement is included with the disclosed dara. The detecminaaon of the responsible authority may be appealed puisuant to the provisions of the administrative procedure act relating[o contested cases. DATA PRIVACY :�DVISORY In accordance with M.S. 13.04, Subd. 2, "Rights of subjecu 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. 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 permit or license. 4. If your requested permit or license requires Council action to approve, some information may become public. 5. You have certaim 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. I o vh � 6�G��crn� - First Middle Last �h�r3 �-h.�t�,�- ��✓r/ Address 4�Qt°.Q f/l��✓ �`ll ��.�7 Ciry Stace Zip Phone I understand my rights as stated above. � � Sig ature 10