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i Sea 13.04 RIGHTS OF SUBJECTS OF D�TA Subd. 1. Type of data. The righrs of individual on whom[he data is stored or to be scored shall be as set fonh in this secrion. Subd.2. Information reqtrired to be given individual. An individual asked to supply private or confidendal data concerning himself shall be informed of: (a)the purpose and intended use of the requested data wichin the collecdng'state agency, polidcal subdivision,or sratewide system; (b)whether he may refuse or is legally required to supply the requested data;(c)any Irnown consequence arising fmm his suppiying or refusing to supply privace or confidendal data;and(d)the iden�iry of other persoas or enrides auchorized by state or federal iaw to receive the data. This requuement shall not apply when an individual is asked to supply invesrieadve dara, pursuant to section 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of re�enue mav place the notice reauired under this subdivision in the individual income tax or propem tax refund instructions instead of on those forms. Subd. 3. Access to data by indiriduai. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public, private or confidendal. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data wichout any charge to him and, if he desires, shall be informed of the content and meaning of[hat data. Afrer an individual has been shown the private data and informed of its meaning,the data need not be disc(osed to hirn for six months thereafter unless a dispute or acrion pursuan[to chis secdon is pending or addidonal data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of che data. The responsible authoriry may require the requesring person to pay the actual cosu of making, certifying,and compiling the copies. The responsible authoriry shall comply immediately, if possibie, with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is noc possibie. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addidonal five days wichin 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 pri�•ate data concerning himself. To exercise chis right,an individual shall noafy in writing the responsible authoriry describing the namre of the disagreement. The responsible auchoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplece and attempt to norify past recipienu of inaccurate or incomplete data, including recipients named by che individual; or(b)norify the individual that he believes che data to be correct. Data in dispute shali be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determinaaon of the responsible authority may be appealed pursuant to the provisions of the administradve procedure act relating [o 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 pernut 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 permit or license requested. 2. You may refuse to supply data, but refusal may require that the Ciry deny the pemut 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 yourself. 6. Your full name is required to process this application or permit. � ; / / // i/ � ! �� Lasc First �� Mid,dle - ) , � i'j / � 'E � L G' v Address / � �' I� / .' , _ � �� ',�� Ciry I State Zip Phone I understan� my rights as stated �ve. ,, , / _ . Signamre