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Scc.13.04 RIG1iTS OF SUBJECTS OT DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set iorth in this section. Subd.2. lnfonnation required to be given individual. An individual asked to supply private orcontidential data conceming himselfshall be informed of. (a)the purpose and intended use of the requested dala within the col lecting sta[e agency,political subdivision,or statewide systein;(b) whether he may refuse or is legally 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 tederal law[o receive the data. This requirement shal I not apply when an individual is askcd to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement ofl�icer. 7'he commissioner of revenue may place the notice required under this subdivision in the individual income tax or property tax refund instructions instead of on those fonns. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informcd whether he is the subject of stored data on individuals,and wheHler it is classified as public,private or eonfidentiaL Upon his further request,an individual who is the subject of stored private or publ ic data on individuals shall be shown the data without any charge fo him and,if he desires,shall be informed of the content and meaning of that data. Afier an individuai has been shown dic private data and infonned of its meaning,thc data necd not be disclosed to him for six months thereatler unless a dispute or action pursuant to this section is pending or additional data on the individual has been coi lected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject ofthe data. The responsible authority may require the requesting person to pay die actual costs of making,certif'ying,and compiling the copies. The responsible authority shall comply immcdiately,if possible,with any requesl made pursuant to this subdivision,or within tive days of the date of the request,e�cluding Saturdays,3undays and legal ho�idays,if immediate compliance is not possible. [f he cannot comply wiUi the requesl within diac timc,he shall so inform the individual,and may have an additional tive days within which to comply with the request,escluding Saturdays, Sundays and legal holidays. Subd.4. Procedure�vhen data is no[accurate or complete. An individual may contest the accuracy or completcness of public or private data conceming himself. To exercise this right,an individual shall notify in�vriting the responsible authoriry describing the nature ofthe disagreement.The responsible authority shall within 30 days either (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual tha[he believes the data to be correcL Data in dispute shall be disclosed only if the individual's statement of disagreement is included with Uie disclosed da[a. The detcrmination of the responsible authority may be appealed pursuant to thc provisions of the administrative procedure act relating to contested cases. DATA PRIVACY ADVISORY ln accordance with M.S. 13.04,Subd.2,"Rights of subjects of data",we would lihe to infom�you that your request for a pern�it or license from the City of Orono or any of its departments may require you to furnish certain private or confidential infonnation. You are notified that: 1. The infonnation you furnish will be used to detennine 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 inforniation 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 pennit. � First Middle ' Last � Address f�� .�� City State Zip Phonc I understa my ' ts as stated above. / l . //.7-s�Ji .-�l/' Signature Reset Form 32