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. Sec.13.04 RIGHTS OF SUBJECT'S OF DATA � 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 section. Subd.2. Information reyuireci to be given individual.An individual asked to suppiy private or wnfidential data�ronc:eming himself sha11 be intormed oP: (a)the purpose and intended use of the requested data within the coliecting state agency,political subdivision,or statewide system;(b1 whether he may refuse or is legally required to supply the requested da[a;(c)any known consequence azising from his supplying or refusing to supply private or c;onfidential clata;and(d)the identity of other persons or en[ities authorizeci by state or(ecieral law to receive[he daia.This reyuirement shall not applq wtcen an individuat is asked ro supptq investigaticz daca,parsuan[to section�3.82,subdrvisian 5,to a lawenton�ment ot�icer. The conunissioner oY revenue ma}place the notice reauired under this subdivision in the individual income tax or prooertv taY 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 subiect of stored data on individuals,and whether it is classified as public,private or contidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data without arry charge to him anci,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 him for six months thereafter uniess a dfspute or action pursuant to this section is pending or additiona(data on the individua(has been coflected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authorit} may require the requesting person to pay the actual costs of making certifying,and compiling the copies. The responsible authority shall comply immediately,ifpossibie,with any reyuest made pursuant to this subdivision,or within tive days of Yne date of the request,excfuding Satuniays,Sundays and tega{holi�ays,if immediate comptiance is not possible.if he cannot wmpfy with the request within that time,he shail so inform the individual,and may have an additional five days within which to c;omply with the request,excluding Saturdays, Sundays and Iegal holidays. Subd.4. Pra,�d�re wfien dsts is rrot�a„urste or oomp�ete.An indiu�idusJ arsy contest the ac�urscy arrnmptetertess ofpubric:or prio�te ctara concerning himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. The responsible authorit}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)�otify the individual that he believes the data to be correct. Data in dispute shall be disclos�ed only it�the individuat's statemeni of disagreement 1s inctuded wich the d+sclosed data. The determination ofthe responsible authority ma}�be appealed pursuant to the provisions ofthe administrative procedure act relating to contested cases. ➢.4T'A PRIVACYADVISORY in aecordanee 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: I. The intormation 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 permit or license. 3. The 'snfosmat'son may be stsared�v'stk� otl�es 1oca1, state or fe�iesa�agenc'ses to the extent necessar} to process the permit or license. 4. If your requested permit or license requires Council action to approve,some information may become pub)i c. 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 permit. --� � - ��1/� i� / First � Middle Last f Address Ciiy State 2ip Phone I understand my rights as stated above. � ..._.._ _ _..__.� � . _ / �--- „_......�� -. Signature �� Reset Fortn ' 32 �'�.;, �