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R Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The righcs of individual on whom che data is stored or to be scorcd shall be as set fonh ia this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply privace or confidenrial data concerning himself shall be informed of: (a)the purpose and in�ended use of the requesied data within the collecaag'stace agency,polidcal subdivision,or stacewide systcm; (b)whether he may refuse oY is legaliy requiced to suppiy ehe requesced data;(c)any Irnown coasequence arising from his supplying or refusing to supply priva[e or confidendai data;and(d)the idenary of ocher persoas or enaues authorized by state or federal law to receive tize data. This requirement shall not apply when an individual is asked to supply invesdgadve dara,pursuan[to secdon 13.82,subdivision 5, to a law enforcemenc officer. The commissioner of re�•enue mav place the nodce reauircd under this subdivision in the individual income tax or propem tax refund instructions inscead of on those forms. Subd. 3. Access to data by individual. Upon requesc to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whe[her it is classified as public, priva[e or confidendal. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown che data wi�hout any charge to him and, if he desires, shall be informed of the contenc and meaning of[hat data. After an individual has been shown[he private data and informed of its meaning,the dara need not be disclosed to him for six monchs thereafter unless a dispute or acdon pursuanc to this secdon is pending oc addidonal data on the individual has been collected or creaced. 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 requesring person to pay the actual costs of makinz,cerafying, and compiling the copies. The responsible au[horiry shall comply immediately, if possible, wi[h any request made punuant to this subdivision,or wi[hin five days of the date of the requesc,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request wichin[hat dme,he shatl so inform[he individual,and may have an addiaonal five days wichin which to compiy with the request,excluding 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 chis right,an individual shall noafy in wridng[he responsible authoriry describing the nature of the disagreement. The responsible authority shali within 30 days either: (a)correct the data found to be inaccurnte or incomplete and aaemp�to nodfy past recipienu of inaccurate or incomple�e data, ineiuding recipients named by the individual;or(b)nodfy the individual tha[he be(ieves the data to be cocrect. Data in dispuce shall be disclosed only if[he individual's statemenc of disagreemenc is included with the disc(osed data. The determinaaon of the responsible authority may be appealed punuant to the provisions of the adminiscrarive procedure act relaang to contesred cases DATA PRIVACY ADVISORY In accordance wich 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 permit or license. 3. The information may be shared wich ocher 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 perm.it. -� �a�� iv w�- � /�� Cv��r�� First ] , d e Last ��L�� .'� �'1'e��J ��-Cf Ad «55 tUU �J ` ( r,/� � �/"y � �,( c,�-��. i�--� ��/ L ��l lC Ciry Snre Z�p Phone I unders d my rights as stated above % � � � ��-. � .�C�^-�l, ' na e v�