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, � � Sea13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Information reqtrired to be given individual. An individual azked to supply private or confidendal data concerning himself shall be informed of: (a)the purpose and inunded use of the requesred dara within the coileccing�rate agency,poliacal subdivision,or sratewide rystem; (b)whether he may refuse oY is legally required to supply[he cequested data;(c)any known coasequence arising from his supplying or refusing to supply private or confidendal data;and(d)the idendry of other persons or endaes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesrigadve dara,pursuant to secrion 13.82, subdivision 5,to a law enforcement o�cer. The commissioner of revenue mav pface the nodce reouired under this subdivision in the individual income tax or Dropertv tax refund instrucaons instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject � of scored data on individuais,and whe[her it is class�ed as public, privace or confidenaal. Upon his further request,an individual who is the subjecc 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 concent and meaning of that data. After an individual has been shown the privace data and informed of its meaning,the data need not be disclosed to him for six monchs thereafter unless a dispute or acdon pursuant to this secdon is pending or addidonal dara on the individual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual costs of making, certifying,and compiling the copies. The responsib(e authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision, or within five days of the date of the request,excluding Sacurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comp(y with the request within that time,he shall so inform the individual,and may have an addidonal five days within which to comply 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 conceming himself. To exercise chis righc,an individual shall nodfy in wriring 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 nodfy past recipienu of inaccurate or incomplete data, including recipients named by the individual; or @)nodfy the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreemenc is included wich the disclosed data. The deternunarion of the responsible auchoriry may be appealed pursuanc to the provisions of the adaunistradve procedure act relaring to conrested 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 pemut or license from the City of Orono or any of its departments may require you to fumish certain private or confidential information. You are notified that: 1. The information you furnish will be used to detemune 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 with other local, state or federal agencies to the eztent 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. �r � r�� First iddle Last . � w . Ad�s _�1�LJ �!V - ��--�SJ� `1 �(�^�C�ol-I � 0� City State Zip Phone I understand my rights stated above. � �J Z' � V Signature