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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 srored or to be stored shall be as set forth in this section. Subd.2. Information required to be given individual.An individual asked to supply private or confidential data conceming himself shall 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 rcfuse or is legally required to supply the requested data;(c)any kno�vn consequence arising from his supplying or refusing to supply priva[e or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked[o supply investigative data,pursuant to section 13.52,subdivision 5,to a law enforcement officer. The commissioner of revenue mav�lace the notice required under this subdivision in the individual income tac or pronertv tat refund instructions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible auchority,an individuzl shall be informed whether he is the subject of storeddata on individuals,.and whether it is classified as public,private or confidential. Upon his fui7her request,an individual who is the subject of stored private or public data on individuals shall be sho`vn the data�vidlout any charge to him and,if he desires,shall be informed of[he content and mea�ing 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 action pursuan[to this section is pending or additional data 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 cosLS of making,certifying,and compiling the copies. The responsible au[hority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five da}'s ei the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate comptiance is not possible.1f he canno[comply with the request within that time,he shall so inform the individual,and may have an additional five days�vidlin which to complywith the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when da[a is not accurate or complete. An individual may contest the accuracy or complete�ess of public or private data concerning himself. To exercise[his right,an individual shall no:ify in wiiting the responsible authonty describing the nature of[he 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[he data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with che disdosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relacing to contested cases. DATA PRIVACY'ADVISORY In accordance�vith M.S. 13.04,Subd.2,"Rights of subj ects 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 perniit 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 perniit or license. 4. If your requested permit or iicense 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. � , i � �,�� ,l S � ._l.-L L C(; w. �i,�-1 .��/ First Middle Last 2�.^ l��' �,VL� �I�� . Address �,{.�r.�f ;�nr,� �MN - ��3� � °I S �-'�^7l -`�'� �� C�ty State Zip Phone I un stand }�rights state bove. Sign u 11 32