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Sec.13.04 RIGHTS OF SUBJECTS OF D�TA Subd. 1. Type of data. The rights of individual on whom[he data is stored or to be stored shall be as set fonh in this secaon. Subd.2. Information reqirired to be given indiridual. r1n individual asked to supply private or confidential data conceming himself shall be informed of: (a)the purpose and incended use of the requesrEd data within the collecting"state agency, political subdivision,or sratewide system; (b)whether he may refuse oY is legally required ro suppty the requested data;(c)any f�own consequence arising from his supplying or refusing to supply • private or confidenrial data;and(d)the idendcy of ocher persons or enuaes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked co supply invesrieaave data, purs�ant to secaon 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of re�enue mav place the nodce reauired under this subdivision in the individual income tax or propertv tax refund instructions instead of on those forms. Subd. 3. Access to data by indi�ldual. Upon request 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, private or confidenual. 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 hun and, if he desires, shall be informed of the content and meaning of[hat data. After an individual has been shown the private data and informed of its meaning,che data need not be disclosed to hun for six months thereafrer unless a dispute or acrion pursuant to this section 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[he data. The responsible authority may require the requesang person to pay the actual costs of makine, certifying, and compiling the copies. The responsible auchoriry 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 wi[h the request within that tune,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,excluding Sarurdays, 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 pm•ate data conceming himself. To exercise this rieht,an individual shall nodfy in writing the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to norify past recipienu of inaccurate or incomplete data, inciuding recipients named by the individual; or(b)noUfy ihe individual tha[he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The de[ermination of the responsible authoriry may be appealed pursuant to the provisions of the adaunistraRve procedure act reladng 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 permit 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 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 permit. First Middle Lasc Address City State Zip Phone I understand m rights as stated ove. �-�-�'�� -� Signature