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--- � . � Sec.13.04 RIGHTS OF SLJB.TECTS OF D�Ta Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal data concerning himself shall be informed of: (a)the purpose and intended use of the requested dara within the collecting"state agency, poliricai subdivision,or statewide system; (b)whether he may refuse oY 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)[he idenriry of other penons or enddes authorized by state or federal law to receive the data. This requirement shall noc apply when an individual is asked to supply invesrieadve dara, pursuan[to secaon 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav piace the nodce required under this subdivision in the individual income tax or proper[V tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whe[her he is the subject of stored data on individuals,and whether it is classified as public, private or confidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data without any charge to hirn 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 him for six months thereafter unless a dispute or acrion pursuant to this secdon is pending or addiUonal 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 respon$ible authority may require the requesting person to pay the actual costs 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 time,he shall so inform the individual,and may have an addiaonal five days within which to comply with the request,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 right,an individual shall notify in writing the responsible authoriry describing the namre of the disagreement. The responsible auchoriry shall within 30 days eicher. (a)correct the data found ro be inaccurate or incomplete and attempt ro noufy past recipients of inaccurate or incomplete data, inciuding recipients named by the individuai; or(b)notify the individual that he believes the data to be correct. Data in dispute shali be disciosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act relaang 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 pemut 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 extent necessary to process the pernut or license. 4. If your requested permit or license requires Council action to approve, some information may become pubiic. 5. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. (. Your full name is required to process this application or permit. �� ,..- �I�� r-Zc/< ��.r�i�-�-�7 cS First Middle Last Y1� -� , ; �� ► ��,,, � , -� �;r , �-� � Address �,��j �j_�1 � �,-� .�'�-Irrr�� `�=� � ��-�� ' - Ciry � State Zip Phone I understand my rights as stated above. -- � � f�_ - --�� ',-- Signacure /