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\ Sec.13.04 RIGHTS OFSUBJECTS OFDATA j � Subdivrsron I. Type ojdata. The rights of individua!on whom the data is stored or to be stored shall be as set forth in thrs section. � Subd.2. Injormation required to be given individuaL An individual asked to supply private or confidentra!data concerning himself shal!be informed of (a)the purpose and intended use of the requested data wrthin the callecting state agency,political subdivisron,or statewide system;(b)whether he may refuse or is lega/!y required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply prtvate or confrdential data,-and(d)the identity of other persons or entities authorized by state or federal Imv to recerve the data. This requirement shall not apply when an rndividua!is asked lo supply investigatrve data,pursuant to section /3.82, subdivision 5, to a law enforcement o�cer. The commissroner ofrevenue may place the notice required under this subdivision in the individual income tax or propertv tax refund rnstructiorts rnstead o(on lhose rorms. Subd.3. Access to data by individuaL Upon request to a responsible authority,an indivrdual shall be informed whether he rs the subject of stored data an individua/s, and whether it is classifred as public,private or confidential. Upon his further request,an individua!who is the subject of slored private or public data on rndividuals shall be shown the data without any charge to him and, if he desires,sha!!be injorined of the content and meanrng of that data. After an individua!has been shotivn the private data and informed of r1s meaning, Ihe data need no1 be disclosed to him for srx months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collecled or created. The responsible authoriry shall provrde copies of the prrvale or public data upon request by the individua[subject oj the data. 77re responsible authorrty may require the requesting person to pay the acrua!costs of making,certifying,and compiling tf�e copies. The responsible authority shal!comply rmmediately,ifpossible,with any request made pursuant to this subdivision,or ia�rthin five days of the date ojthe request,excluding Saturdays,Sundays and legal holidays,if immedrate compliance is not possib/e. /f he cannot comply with the request within that time,he shal!so infarm the individual,and may have an additionalfive days ivithin which to comply with the request,excluding Saturdays,Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An indivrdual may contest the accuracy or completeness ofpublrc or private data concernrng himself. To exercise this right, an indrvidual sha!/no[ify in writing the responsib[e authority describing the nature of 1he disagreemen[. The responsible authority shall within 30 days either.• (a)correct the datafound to be rnaccurate or incomplete and att2mpt to not� past recipients of inaccurate or incomplete data,including recrpients named by the indivrdual;or(6)not�the individual lhat he belreves the data to be correcr. Data in drspute shall be disclosed only if the indrvidual's statement ojdisagreement rs rncluded with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to contested cases. DATA PR/VACYADvlSORY Inaccordancewrth,b�S.13.04,Subd.2, "Rightsofsubjectsofdara",wewouldliketornformyourhatyourregues�jorapermrtorlrcense from the Ciry of Orono or any of its departments may require you to furnish certain private or confidentia!information. You are notified that: I. The information you furnish wil!be used to determine your qualrfrcation for the permit or license reguested. ?. You may refuse to supply data,but refusa!may requrre that the Ciry deny the permit or/icense. 3. The informairon may be shared with other local,state or jederal agencies to the extent necessary to process the permit or [rcense. -l. If your requested permit or lrcense reguires Council action to approve,some information may become public. .i. You have certarn rights under M.S. 13.04(see following page)to revieiv private data on yourself. 6. Your full name is required to process this application or permit. PLEASE PRLNT First Middle Last Address Crty SJate Zip Phone 1 understand my rights as stated above. Srgnature !0