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' • � � Sec.13.04 RIGHTS OF S[JB.TECTS OF DATA Subd. 1. Type of data. The righcs of individual on whom the data is s[ored or to be scored shall be as set forth in this secrion. Subd.2. Information req�rired to be given individual. An individual asked ro supply private or confidendal data concerning himseif shall be informed of: (a)the purpose and intended use of the requested dara wirhin the collecang'state agency, potidcal subdivisioo,or sratewide system; (b)whe[her he may refuse oY is legally required to supply the requested data;(c)any lmown consequence arising fmm his supplying or refusing to supply � privace or confidenrial data;and(d)the idenaty of other persons or enaaes au[horized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesrieauve dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. . The commissioner of revenue mav place the noace reauired under this subdivision in the individual income tax or propertv tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals, and wherher it is classified as public, privace or confidendal. Upon his further request, an individual who is the subject of stored private or public data on individuais shall be shown the data wichout any charge to him and, if he desires, shall be informed of the content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to hun for six months thereafter unless a dispute or acdon pursuant to this secaon is pending or addidonal data on the individual has been collected or created. The responsible authoriry shalt provide copies of the private or pubiic data upon requesc by the individual subjec[of the data. The responsible authoriry may require the requesting person to pay the acrual cosu 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 noc possible. ff he cannot comply with the request within that time,he shall so inform the individual,and may have an addi[ional five days within which to comply with Ihe reque�t,exciuding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this rieht,an individual shall norify in writing che responsible authoriry describing the nature of the disagreement. The responsib(e authority shall within 30 days eicher: (a)correct the data found to be inaccurate or incomple[e and attempt to nodfy past recipients of inaccurate or incomplete data, inciuding recipients named by che individual; or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disc(osed data. The determinarion of the responsible authoriry may be appealed pursuan[to the provisions of the administcarive procedure act relating 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 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 pemut or license. 3. The information may be shared with other local, state or federal agencies to the excent necessary to process the permit or license. 4. If your requested permit or license requires Council action to approve, some information may become public. j, 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 permit. �C , ` ` �� First � Middle Last . v a�� Address �Gr.�\� � ' \�J �� / �•� ��c` ' �� �,t� �� race �,� o� Ciry T— .,..., I understand my rig s as stated above. � "� ��" - Signature