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Sec.13.04 RIGHTS OF SUBJECTS OF DATA 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. Information requircd to be given individual. An individual asked to supply private or confidential data concerning himself shali be infonned of: (a)the purpose and intended usc of the requested data�vithin the co!lecting state agency,political suhdivisioo,or statewide system;(b) whether he may refuse or•is legally required to supply the requo�sted ci:ita;(c)any known conseyuence arising from his supplying or refusing to supply private or confidential data;and(d)the identity of other persons or entities autht�rized by s[ate or federal law to receive the data. This requirement shali not apply whert an individua(is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue mav place ihe notice required under this subdivision in the individual income tar or,pronertv tax�efund. instructions instead of on those fonns. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be infonned whether he is the subject of stored data on individuais,and whether it is classified as public,private or contidential. Upon his further reyuest,an individual who is the subject of stored private or public data on individuals shall be shown the data without any ch�rge to him and,if he desires,shall be infonned of the content and meaning of that data. ARer an individual has been shown the private data and infornied of its mcaning,the data neect not be disclosed to him fior six 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 responsibie authoriry sha(I provide copies of the private or public data upon reques[by the individual subject of the data. The responsible authority may require the reques[ing person to pay the actual costs of making,cettifying,and compiling the copies. 'ihe responsible authority shall comply immediately,it�Fwssible,with any request made pursuant to this subdivision,or within five days of the dlte of the request,exc(uding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. [f he cannot comply with the requc�st within that time,he shall so infonn the individual,and may have an additional tive days within which ro comply with the request,exduding Saturdays, Sundays and legat holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private daG1 concerning himselE To exc.�•cise this�ight,an individual shall notify in writing the responsib(e auUio�ity describing the nature of th�disagreement. The responsible authonty shall within 30 days either: (a)correct the data found to be i�accurate or incomplete and attempt to notiYy past recipients of inacew-ate or incomplete da[a,induding recipients naroed by the individual;or(b)notify the individual that he believes the data to be con•ecL Data in dispute shall be disclosed only if thc individual's statement of disagreement is included with the disclosed data. The detennination of the res}wnsibfe authority may be appealed pursuant to the provisions of the administiative 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 infonn you that your request for a perxnit or ticense 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 pemlit 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 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 your�elf. 6. Your full name is required to process this appiication or permit. �C�.�( � �7 � l� 1 C�v'v� �� I �� l�(-''�'r�"�- First ;�liddle Last ��``� C,�'�.'.. \��J ,� c.,`.: {�11�2 Address _- _. � . � � C3��3 �iv `�� .��C �i�_``�o�t�.� — L)�J ) Cit}• Statc Zip Phon^ I understand my rights as stated above. ��=l/l Signature