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Sec.13.04 RIGHTS OF StiBJECTS OF D9TA Subd. l. Type of data The rights of individual on whom d�e data is stored or to be stored shall be as set forth in this section. ---- ----Subd..2._Information.required_to be.given indieidual.An individuaLaskedto.suppl.y_pri.vate.or.confidential.dataconce�ninghimselfshall be _________,_ informed of: (a)the purpose and intended use of die requested data within the collecting state agency,political subdivision,or statewide system;(b) whether he may refuse or is le�al ly 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 identity of other 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 investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue mayplace the notice reguired under this subdivision in the individual income tax or property taz 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�vhether it is classified as public,private or contidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be sho�vn the data without any charae to him and,if he desires,shall be infonned of the content and meanine of that data. Afrer 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 action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon reques[by the individual subject of the data. The responsible authoriry may require the requesting person to pay the actual costs of making,certifying,and compilin�the copies. The responsible authority shall compiy immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date oY the request,excluding Saturdays,Sundays and 1eg11 holida_ys,if immediate compliance is not possible [f he cannotcomply with the request wid�in that time,he shall so inform d�e individual,and may have an additional five days�vithin 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 public or private data concerning himselF. To exercise diis ri�hc,an individual shall notify in writing the responsible authority describing the nature of the disagreement. The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notity past recipients of inaccurate or incomplete data,includine 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 detennination of the responsible authority may be appealed pursuant to the provisions of the administrative 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 inforn�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: l. The infonnation you fumish will be used to deterniine 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 pennit or license. =1. If your requested permit or license requires Council action to approve, some information may become public. 5. You have certain rights under l�t.S. 13.04(available upon request)to review private data on yourself. 6. I'our full name is required to process this application or permit. �01��D M,l�}-��- I f�U I V� First �tiddle C,ast � � S� 00 U/��ZtrT�- ��-�/b • , S l.� I T� � � Address �-1'2�C"�- , /�'t � , 5�� I �SZ- �-ZS - I ZZ� Cih� State Zip Phone I understand mv rights as at ��bove. Signaturc .i?