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Scc.13.0�1 RIGFITS OF SUBJECTS OF Dr�TA Subd. 1. 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. Infonnation required to be given individual. An individual asked to supply private or confideiitial data concerning himselfshall 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 or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusine 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 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 ma�olace the notice reauired under this subdivision in the individual income tax or property tax refund instructions instead of on those fonns. Subd.3. Access to data by individuaL Upon request to a responsible authonry,an individual sliall be infortned whether he is the subject of stored data on individuals,and whether it is classitied as public,private or contidential. Upon his fuRher 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 infonned of the content and meaning of that data. After an individual has been shown the private data and infonned of i[s meaning,the data need not be disclosed to him for sia months Niereafter 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 shafl provide copies ofthe private or pubiic data upon request by the individual subject ofthe da[a. The responsible authoriry may require the requesting person ro pay the actual costs of making,certifying,and compiling the copies. The responsible authority shal I comply immediately,if possible,widi any request made pursuant to this subdivision,or within tive days of the date ofthe request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. [flle cannot comply with the request within that time,he shall so infonn the individual,and may have an additional tive days within which to comply with the request,excluding Saturdays, Sundays and legal holidays, Subd.4. Procedure�vhen data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data conceming himself. To exercise this right,an individual shall notify 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 attempt to notify past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disa�reement is included with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to contested cases. DATA PRIVACY ADVISORY ln 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 deternline your qualification for the permit or license rec�uested. 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 pennit 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. - �_ . cb S -� First �liddle L�st � .. ( ��s� �� sr�;,- �/<�� tlddress �� ` �� ��7 /� � %��r �SJ�J ( O City State Zip Phone I understand my rights �tated above. �� Signaturc Reset Form �2