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. , z Sec.13.04 RIGH'CS OF SUBJGC"I'S OF DATA Subd. l. 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 required to be given individuaL An individual asked to supply private orcontidential data conceming himseifshall be infonned oY`. (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b) whether he may refuse or is legally reyuired to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data.This rcquirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a Iaw enforcement officer. Thc commissioner of revenue may place the notice required under this subdivision in the individual income tax or property tax refiu�d instructions instead of on lhose fonns. Subd.3. Access to data by individua�. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and�vhether it is classitied 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 him and,if he desires,shall be informed ofthe content and mcaning of that data ACter an individual has been sho�+m thc private data and informed of its meaning,the data need not be disclosed to him for six mondls thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authority shall pro��ide copies of the private or public dala upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. Thc responsible authority shall comply immediately,ifpossible,wiNi any requcst made pursuant to this subdivision,or within tive days of the date ot'thc request,excluding Saturdays,Sundays and legal hol idays,if immediate compl iance is not possible. If he cannot comply with the requcst witliin that time,he shall so intbrm thc individual,and may have an additional five days within which to comply with thc reques[,c�cluding Saturdays, Sundays and Icgal holidays. Subd.4. Procedure when data is not accurate or complcte. An individual may contest the accuracy or complctcncss of public or private da[a conccrninghimsel£ Toexercisethisrigh(,anindividualshallnotifyinwritingtheresponsibleauthoritydescribingthenaturcofthedisagreemcnt. The responsible authority shall wilhin 30 days cither (a)correct the data found to he inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,induding recipients named by[hc individual;or(b)notity ihe individual that he bclieves the data to be correct. Data in dispute shall be disclosed only if die individual's statcment of disagreement is included with the disclosed data. The determination of[he responsible authority may be appealed pursuant to the provisions of the administrative procedure act rclating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04,Subd.2,"Rights of subjects of data",we would like to infomi you that your request for a pennit or license from the City of Orono or any of its departments may rcquire you to furnish certain private or confidential infonnation. You are notifed that: 1. The infonnation you furnish will be used to detemline your qualification for the pennit 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 permit or license requires Council action to approve, some information may become public. 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 pennit. �v�-._ � �-�-,�, ��„-sc R1iddlc �.�5� Adtiress Cit}° State "l,ip Vhunc 1 understand my rights as stated above. Signaturc .i?