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. � Sec.13.04 RIGHTS OF SLIS.TECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the dara is stored or to be stored shall be as set forth in this secdon. Subd.2. Information reqiric�ed to be given individual. An individual asked ro suppiy private or confidenual data conceming himself shall be informed of: (a)the purpose and intended use of the requesced data within the collecting'state agency,polidcal subdivision,or statewide system; (b)whe[her he may refuse oY is legally required to supply the requested data;(c)any Irnown consequence arising from his supplying or refusing to suppty private or confidential data;and(d)the idenrity of other persons or enrides au[horized by state or federal law to receive the data. This requirement shall not apply when an individuai is asked to supply invesrigadve dara, pursuanc to secrion 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav place the nodce reauired under this subdivision in the individual income tax o�proper[v tax refund instruccions 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 data on individuals, and whe�her it is classified as public, private or confidenrial. Upon his further request,an individual who is the subject of stored priva[e 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 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 o�acrion pursuanc to this sec:ion is pending or additional 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 the data. The responsible authoriry may require the requesdng person to pay the actual costs of making, cenifying, and compiling the copies. The cesponsible authority shall comply immediately, if possible, 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 not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addiaonal 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 concerning himself. To exercise this right,an individual shall notify in wridng 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 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 induded with the disclosed data. The determinarion of the responsible authoriry may be appealed pursuant to the provisions of the administradve 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 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 pemut or license requested. 2. You may refuse to supply data, but refusal may require that the City 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 pernut or license. 4. If your requested pernut or license requires Council action to approve, some information may become pubiic. j. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. (. Your full name is required to process this application or permit. `r , � 1'� � U� �I (/ � ��1�F�'� First Midd Last �� I I �� Address � � ��! _' �� 4��=��N� - � ,� ��-� City State Zip Phone I understand my g t��stated above. /�'f��' ,/.1_�"`��." - Signature %