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y . • Sec.13.04 RIGHTSOFSUBJECTSOFDATA . Subdivision 1. Type of data. The rights of rndividual on whom the data is stored or to be stored shall be as set forth rn thrs section. � Subd.2. Information required to be given individual An individual asked to supply private or confidentia[data concerning himselj shall be informed of.' (a)the purpose and intended use of the requested data withrn the collecting state agency,political subdivision,or statewide system;(b)whelher he may refuse or is legally required to supply the requested data;(c)any known cansequence arising from his supplyrng or refusrng to supply private or confdential data;and(d)the idenlity of other persons or entities authorized by state or federal lativ lo receive the data. Thrs requirement shall not apply when an individual rs asked to supply investrgative data,pursuant to section 13.82, subdivision S, to a Imv enjorcement ojfrcer. The commissioner ofrevenue may place lhe notice required under this subdivision in the indivrdual income tar or property tax refund instrttctions instead af on those jorms. Subd.3. A ccess to data by individual. Upon request to a responsible authorrry,an indrvrdual shal!be informed whether he is the subject of stored data on individuals, and whelher it is classifred as publrc,private or confidential. Upon his further request,an indivrdual who is the subject of stored prrvate or publrc data on individuals shall be shoivn the data ivithout any charge to hrm and,ijhe desires,shall be informed of the content and meaning of that data. After an individual has been sholvn the private data and informed ojits meaning, the data need not be drsclosed to him for srx months thereajTer unless a dispute or action pursuant to thrs section is pending or additional datu on the individual has been collected or created. The responsible authorrry shall provide copies of the private or public data upon request by the rndrvidua!subject of 1he data. The respansible authority may require the requesting person to pay lhe actua!costs of makrng,cert�ing,and compiling the copies. The responsible authorrty shall comply immediately,ifpossrble,with any request made pursuant to this subdivision,or�vithin five days of the date of the request,excluding Saturdays,Sundays and legal holidays,rjimmediate compliarice is not possible. If he cannot comply ia�ilh the request within that time,he shall so injorm the indrvidual,and may have an addrtional frve days tivithin 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 ofpublrc or private data concernrng himself. To exercise this righl, an individual shall not�in writing the responsrble authority describing the nature of the disagreement. The responsible authority shal!wilhrn 30 days either: (aJ correct the data found to be inaccurate or incomplete and attempt to not� past recipients oJrnaccurate or incomplete data,including reciprents named by the indrvidual;or(b)notify the individua!that he believes the data to be correct. Data in drspute shall be disclosed only rf the rndividual's statement ojdrsagreement is included with the discfosed data. The determination of the responsible authority may be appealed pursuant to the provrsions of the adminrstrative procedure act relating to contested cases. DATA PRIVACYADVISORY In accordance wilh MS.13.04,Subd.2, "Rights ofsubjects ofdata",tive would like to inform you thatyour requestfor a permit or license jrom the City 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 or license requested. 2. You may refuse to supply data,but rejusal may require that lhe Ciry deny the permrt or license. 3. The information may be shared wilh other local,srate or federal agencies to the extent necessary to process 1he permit or license. 4. If your requesfed permit or license requrres Council actron to approve,some informalion may become public. S. You have certain rights under M.S. 13.04(see follotiving page)to review prrvate data on yourself. 6. Your fu!!name is required to process this application or permit. PLEASE PRINT � �A s o�1 A(�i�u`��.K First Middle Last LI'�1 SS I�i4Y2.1� c�v�nwtDNs 1�R1J'� � 10�'j Address S;. t_.ov�;S ��Yt-<< �� 'y 1 (0 �12 s� � -8a5 � Ciry State Zip Phone understand m rrgh ated abo ure 10