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' Sec:13.04 RIGHTSOFSUBJECTSOFDATA Subdivision 1. Type ojdata The rights of individual on ivhom the data is stored or to be stored sha[!be as set forth in this section. Subd.2. Jnjormation required ta be given individuaL An individua!asked to supply private or confrdentral data concernrng himself shaf!be informed of.• (a)the purpose and intended use of the requested data within the collecting state agency,polrtical subdivisron,or statewide system;(b)whether he may refuse or is[egally required to supply the reguested data;(c)any known consequence arising from his supplying or refusing to supply prrvate or confrdentral data;and(d)the identity of other pessons or entitres authorized by state orfederal law to receive the data. This reguirement shall not apply when an indivrdual is asked to supply rmestigative data,pursuant to sectron 13.82, subdivisron S, to a!aw enforcement oJfrcer. The commissroner ofrevenue may place the notice re4uired under this subdivision in the indrvidual income taz or property tax refund instructions instead of on those forms. Su6d.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 an individuals, and whether it rs classifred as public,private or confidential. Upon hrs further request,an indrvrdua!who is the subject of stored prrvate or public data on rndivrduals shall be shotivn the data ivrthout arry charge to him and, rf he desires,shall be informed oj the content and meaning ojthat data. After an rndrvidua!has been shown the private data and injormed of its meaning, the dala need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this sectron is pending or additrona!data on the individual has been collected or created. The responsible authoriry shall provide copres o,f'the private or publrc da�a upon request by the individual subject oJ !he data. The responsibfe authority may require the requesting person to pay the act:�al costs of making,certifyrng,and compiling the copies. The responsible authority shall comply immediately,ijpossible,with any request made pursuant to this subdivision,or tivithin five days of the date o,jthe request,excludrng Saturdays,Sundays and lega!holidays,if rmmediate compliance is not possible. If he cannot comply ivith the reqtrest ivithin that time,he shall sa inform the indrvidual,and may have an additionalfrve days tivithin whrch to comply with the request,excluding Suturdays,Sundays and legal holidays. Subd.4. Proeedure when data is not aceurate or complete.An individual may contest the accuracy or completeness ofpublrc or private data concerning hrmself. To exercise this rrght, an individual shall notify in writing the responsrble aulhority describing t{te nature of the disagreement. The responsible authorityshall within 30 days either: (a)correct the datafound to be inaccurate or incomplete and attempt to not� past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notrfy the indrvrdual that he 6elieves the data to be correct. Data in dispute shall be disclosed only if the rndivrdual's statement of disagreement is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant to the provrsions of the administrative procedure act relating to contested cases. DATA PRIVACYADVISORY InaccordancewrthM.S.13.04,Subd.2,"Rightsofsubjectsofdata';ivewouldliketoinformyauthatyourrequestjorapermrtorlicense from the Crty of Orono or any of its departments may require you to furnrsh certain private or confidential information. You are notified that: 1. The information you furnish will be used to determine your qualifrcation for the permit ar/icense requested. 2. You may refuse to supply data,but refusal may requrre that the City deny the permit or license. 3. The injormation may be shared with other local,state or federal agencies to the extent necessary to process the permit or lieense. 4. Ifyour reguested permit or license requires Council actfon lo approve,some rnformation may become public. S. You have certain rrghts under M.S. 13.04(see followrng page)to review private data on yourself. 6. Your ful!name is required to process thrs application or permit. PLEASE PRlNT r��,� �� ..� First Middle Last :�C--' � '�� f"'�— Address � ,{ > �. �G� /"�� `-?�� Ciry State Zrp Phone 1 u dersta my rights as state bove. �L�' Signature 10