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N Sea 13.04 RIGHTS OF SUBJECTS OF DATA Subd. i. Type of data. The righ[s of individual on whom[he data is stored or to be stored shall be as set for[h in this secrion. Subd.2. Information reqirired to be given individual. Art individual asked to supply private or confidendal data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting'state agency,polidcal subdivision,or sratewide system; (b)whether he may refuse or is legally required to supply[he requested data;(c)any lrnown consequence arising from his supplying or refusing to supply privare or coru�dential data;and(d)the identity of other persoc�s or endties authorized by state or fedecal law ro receive the data. This requirement shall not apply when an individual is asked to supply invesoearive dara, pursuanc to section 13.82, subdivision 5, to a law enforcement officer. The commissioner of re enue mav place the norice reauired under this subdivision in the individuai income tax or propertv tax refund instructions instead of on those forms. Subd. 3. Access to data bv individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of s[ored data on individuals, and whether it is classiFied as public, priva[e or confidendal. Upon his further request, an individual who is the subjec[ of stored private or public data on individuals shall be shown the data wichout any charge ro him and, if he desires, shall be informed of the content and meaning of[hat data. Afrzr an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six mon[hs thereafter unless a dispute or acrion pursuant to this secdon is oending or addidonal data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require [he requesting person to pay the actual cosa of makine, certifying, and compiling the copies. The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that tune,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,excluding Sarurdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individua(may contest the accuracy or completeness of public or pri�•ate data concerning himself. To exercise[his rieht,an individual shall nodfy in writing the responsible authoriry describing�he nature of the disagreement. The responsibte au[horiry shall within 30 days either. (a)correct the data found ro be inaccurate or incomplete and attempt to nodfy past recipienu of inaccurate or incomplete data, including recipients named by che individual; or(b)notify the individual that he believes the data to be correct. Data ut dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The de[ermination of the responsible authoriry may be appealed pursuan[to the provisions of the administrarive procedure act relating ro 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 pernut 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 fumish will be used to determine 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 pernut or license requires Council action to approve, some information may become public. j. You have cenain rights under M.S. 13.04 (available upon request) to review private data on yourself. (. Your full name is required to process this applica[ion or permit. .S l 1� �l l�n��s ��4�rt�7�� Firs[ Middle Lasc 32[ Yc� 2to �4v Address �C',�� l�� C� �/V .s�s(J �� S/-3�cF- �S'� C�h, State Zip Phone I understand m riQ t 'as st� \ � C �' Signa[ure �