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Scc.13.04 RIGHTS OF SUBJGCTS OF DATA - Subd. I. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set tbrth in this section. Subd.2. Infonnation required to be given individuaL An individual asked to supply private or confidential data conceming himselfshall be informed of: (a)the purpose and intended use of che requested data within[he collecting state agency,political subdivision,or statewide system;(b) e��hether he may refuse or is le�ally required to supply the reques[ed data;(c)any known consequence arising from his supplying or refusing[o supply private or confidential data;and(d)the identity of ofher persons or entities authorized by state or federal la�v to receive the data. This requirement shal I not apply when an individual is asked to supply investigative data,pursuant to section 13.32,subdivision 5,to a law enforcement officer. The commissioner of revenue may place the notice required under this subdivision in the individual income tax or prooertv tas refund instructions instead of on those fonns. Subd.3. Access to data by individuaL Upon request to a responsible authority,an individual shall be infornied whether he is the subject of stored data on individuals,and whether it is classitied as public,private or contidentiaL Upon his fLrther request,an individual�vho 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 6e infonned of the content and meanin�of dtat data. After an individual has been shown the private data and infonned of its meaning,d�e data need not be disclosed to him for si� months 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 provide copies of the priva[e or public data upon request by the individual subject of the data. The responsible audioriq� may require the requesting person to pay the actual costs of making,certitying,and compiling the copies. The responsible authority shal I compl��immedia[ely,if possible,with any request made pursuant to this subdivision,or�vithin tive days of thedateoftherequest,excludingSaturdays,Sundaysandlegalholidays,ifimmediatecomplianceisnotpossible. [fhecannotcomplywiththerequest within that titne,he shal I so inlorm the individual,and may have an additional tive days within which[o coinply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure�a�hen 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 notih�in writing the responsible authority describing the nature ofthe disagreement. The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempf to notify past recipien[s of inaccurate or incomple[e data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correcL Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination ofthe responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 1.i.04,Subd.2,"Rights of subjects of data",we would like to inform you that your request for a permit or license from tlie 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 deterniine your qualification for the permit 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 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 ri;hts �ulder M.S. 13.04(available upon request)to_review private data on yourself. 6. Your full name is required to p�rocess this application or permit. -�''�� G�J (,Jarr�s �TL First 111iddlr LAst i� �{v'�eG��y G3-� �-e (oa :�dd��s5 I�nr.Q�'� ht 1� 5�3�}� �'S2 44t ��30 c�c�� sta�� ri� P�,o�� I understand n rijhts as st�ted above. W W�� Signaturc Reset Fom� 3�