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, , 1 Sec.13.04 RIGHTS OF SUBJECTS OF D�TA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Informatioo reqirired to be given individual. An individual asked to supply private or confidential dara concerning himself shall be informed of: (a)the purpose and intended use of the requested dara wi[hin the collecting"state agency,polidcal subdivision,or sratewide system; (b)whether he may refuse or is legally required to suppiy the requested data;(c)any Irnown consequence arising from his supplying or refusing to supply private or confidendal data;and(d)the idenriry of ocher persons or enrides authorized by state or federal law to receive the data. This requiremeot shall not apply when an individual is asked to supply invesrieaave dara, pursuant to secdon 13.82, subdivision 5, to a(aw enforcement o�cer. The commissioner of re�enue mav place the nodce reauired under this subdivision in the individual income tax or properN tax refund instructions instead of on those forms. Subd. 3. Access to data by indiriduai. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whe�her it is classified as public, private or confidendal. Upon his further request, an individual who is the subject of stored private or public data on individuals shall be shown che data without any charge to him and, if he desires, shall be informed of the content and meaning of that data. Afte�an individual has been shown[he priva[e data and informed of iu meaning, the data need not be disciosed to him for six months thereafter unless a dispute or acrion pursuant to this section is pending or additional data on the individual has been coliected or created. The responsible authoriry s6a11 provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual costs of makine, certifying, and compiling the copies. The responsible authoriry shall comply immediatety, if possible, with any request made pursuant to this subdivision, or within five days of the date of the request,excluding 3aturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform[he individual,and may have an addidonal five days within which to comply with the request,excluding Saturdays, Sundays and legal hotidays. 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 rieht,an individual shall nodfy in wriang the responsible authority describing�he nature of the disagreement. The responsible authoriry shall within 30 days either. (a)correct the data found ro be inaccurate or incomplete and attempt to norify past recipients of inaccurate or incomplete data, including recipiencs named by the individual; or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disc(osed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant ro the provisions of the administrarive procedure act rela[ing to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "Rights 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 furnish certain private or confidential information. You are notified that: 1. The information you furnish will be used to deternune your qualification for the permit or license requested. Z. You may refuse to supply data, but refusal may require that the City deny the pemut or license. 3, The information may be shared with other local, state or federal a�encies to the extent necessary to process the pernut 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. (. Your full name is required to process this application or permit. Fitst Middle Last Address Ciry � State Zip Phone /, I under d y rights stat� above. i i -, 1��, � Signature