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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 secdon. Subd.2. Information required to be given indiridual. 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 wichin the collecdng state agency,poliacal subdivision,or statewide system;(b)whecher he may refuse or is legally required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply private or confidendal dara;and(d)the idenary of other persons or entiaes authorized by srate or federal law to receive the data. This requirement shall not apply when an individual is asked to suppiy investigadve data, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. "ihe commissioner of revenue mav lace the notice re uired under this subdivision in the individual income taz or ro em tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsibie authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is ctassified as public,private or confidential. Upon his further request,an individual who is the subject of stored private or public daCa 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. Afrer an individual has been shown the private data and informed of iu meaning, the data need not be disclosed[o him for six months thereafter uriless a dispute or acdon pursuant to this secaon is pending or additional data on the individual has been collected or crea[ed. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requestin�person to pay the actual costs of making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possible,with any request made pursuant ro 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 addiriona!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 conceaung himself. To exercise this right,an individual shall notify in writing the responsibfe authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the dara found to be inaccurate or incomplet�and attempt to nocify past recipiznts of inaccurate or incomplete data,including recipients named by the individual;or(b)nodfy 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 determinadon of the responsible authority may be appeafed pursuant to the provisions of the adminis�aave procedure act relaang ro contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "R;ghts 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 permit 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 pemut or license. 4. If your requested pernut 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.�� Y ur full name is required to rocess this application or pernu�. —' ��I ��C�Y�e►h.) � 1�f�V �� Fir� �� r.. � �' iddle� Last 1 r,` Add �-�, .� �{� � � � 1 � � �/ / �� 1 C�ry State Zip Phone I under tand my rights as stated above. yiC �►, Signature 6