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__ � � Sec.13.04 RIGHTS OF SUB.JECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall t�as set fonh in this section. Subd.2. Information required to be given individual. An individual asked to supply private or confidenual data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency, polirical subdi�•ision, 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 refusing to supply private or confidential data; and(d) the identity of other persons or entities authorized by state or federal law ro mceive t�e data. This requirement shall not apply when an individual is asked to supply investigative data, pursuant[o section 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav place the notice required under this subdivision in the individual income tax or property tax refund instructions 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 stored daha on individuals,and whether it is class�ed as pubGc,private or confidential. 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 him and, if he desires, shall be informed of the content and meaning of that data. After an individual has been shown the private data and informed of its meaning, the data need not be disclosed to him for six months thereafter unless a dispute or acUon pursuant to this section is pending or additional data on the individual has bz�n collecred or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. 'Ihe responsible authoriry may require the requesting person to pay the actual cosu of making,certifying, and compiling the copies. The responsit�le authoriry shall comply immediately, if possible, with any request made pursuant to[his subdivision, or within five days of the date of the request,excluding Satuniays,Sundays and legal holidays, if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual, and may have an additional five days within which to comply with[he request, excluding Saturdays, Sundays and legal holidays. . Subd.4. Procedure when data is not accurate or complete. An individual may contest the accunc�•or completeness of public or private data conceming himself. To exercise this right, an individual shall notify in writing the responsible authoriry describing the nanire of the disagreement. The responsible authoriry shall wirh1q30 days either. (a)correct the data found to be inaccurate or incomplete and acL.mpt to nodfy 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 disagreement is included with the disclosed data. The detettnina6on of the respoasib(e authority may be appealefl pursuant to the provisions of the admirusa-ative procedure act relating 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 ��ou to furnish certain private or confidential information. You are notified that: 1. The information you fumish 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 den}� the pemut or license. 3. The information may be shared with other local, state or federal agencies to the e�tent 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 re��iew pri��ate data on yourself. 6. Your full name is required to process this application or permit. SrL�H-E r f �-/��-k. l�r�r�E��or/ First Middle Last 073� C2ES1YIEvV �VE Address �Kd�a M� �S3s6 �iz �>s ��ll— City State Zip Phone I understand my rights as stated above. , /y;�� .��Z��e�-,z.J Signature 10