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Sea13.04 RIGfiTS OF SCfBJECTS OF D�TA Subd. 1. Type of data. The righcs of individual on whom che data is stored or to be stored shall be as set forth ia this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal data concerning himself sha11 be informed of: (a)-the purpose and inrended use of the requested data within the colleccing"state agency,political subdivision,or sratewide system; (b)whether he may refuse oY is legaily required to supply the requested data;(c)any Irnown consequence arising from his supplying or refusing to supply private or confidential data;and(d)the idendry of other persons or enrides authorized by state or federal law to receive the data. 'Ihis requirement shall not apply when an individual is asked to supply invesrigadve dara, pursuant to secrion 13.82,subdivision 5, to a law enforcement o�cer. The commissioner of reeenue mav place che noace reouired under this subdivision in the individual income tax or propem raz refund instrucaons instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public, private or confidenrial. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data wi�hout any charge to him and,-if he desires, shall be informed of the content and meaning of[hat 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 mon[hs thereafter unless a dispute or acaon pursuanc to [his secrion is pending or addidonal data on the individual has been coilected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individua]subject of che data. The responsible authoriry may require the requesdng person to pay the actual costs of making, cerrifying, and compiling the copies. The responsible aurhoriry shall compiy immediately, if possible,wi�h any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saeurdays,Sundays and legal holidays,if immediace 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 wluch 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 public or private data conceming himself. To exercise this right,an individual shall noafy in wriang the responsible authoriry describing�he nacure of the disagreement. The responsible authoriry shall within 30 days either: (a)correct[he data found to be inaccurate or incomplete and attempt to nodfy past recipients 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 individual's statement of disagreemenc is included with the disclosed data. The decermination of the responsible authoriry may be appealed punuant to the provisions of the administradve procedure act relaang to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Ri�hts 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. 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 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. 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. First Middle Last Address City Smte Zip Phone I understand my rights as stated above. Signature