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. , . Sec.13.04 RIGHTS OF SUB.TECTS OF DaT,1 Subd. i. Type of data. The rights of individual on whom[he data is stored or co be scored shall be as set focth in this secaon. Subd.2. Information required to be given individual. ?.n individual asked to supply private or confidenrial data concerning himseif shall be informed of: (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 oY is legally required to supply[he requested data:(c)any{mown consequence arising from his suppiying or refusing to supply private or confidential data;and(d)the identi[y of o[her persons or entides au[horized by state or federal law to receive the data. This requirement shall no[apply when an individual is asked to supply investieaave daci, pursuant ro secdon 13.82, subdivision�, to a law enforcement o�cer. The commissioner of revenue mav place the norice reouired under this subdivision in the individual income tax or propem tax refund instructions ins[ead of on chose forms. _ Subd. 3. Access to data by indi�ldual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whe[her it is classified as public, private or conftdenaal. 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 of the con[enc and meaning of[hat 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 pursuan[to this secaon is pending 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 the requesting person to pay the actual cosu of making,certifying,and compiling the copies. The responsible authoriry shall comply immediately, if possible, wi[h any request made pursuant to this subdivision, or within five days oY the date of the request,excluding 3aturdays,Sundays and leeal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform[he individual,and may have an additional five days wi[hin which[o comply with the request,excluding Saturdays, Sundays and tegal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or pri�•ate data conceming himself. To exercise[his rieht,an individual shall nonfy in wriung the responsible authoriry describing�he narure of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to no[ify past recipienu of inaccurate or incomp(ete data, including recipients named by the individual;or(b)notify the individual[hat he believes[he data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. Ttie determinadon of the responsible authoriry may be appealed pursuant to the provisions of the administrarive procedure act relacing 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 reauest 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 pernut or license requested. 2. You may refuse to supply data, but refusal may require that the Ciry deny the permit or license. 3. The information may be shared with other local, state or federal agencies ro the extent necessary to process the pemrit or license. 4. If your requested pernut or license requires Council action to approve, some information may become pubiic. 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. -��r�� S-�-t'�'�P6" W G/''vt (t' First �fiddle Lasc l �(4� (��.� K �:SZ Address r �� r��aS S�r- Y�t r'' SS�r � C J�',2) �t �o - 2 v�� Ci�, State Zip Phone I understand my rights as stated above. �_ Signature �