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Sec.13.04 RIGHT'S OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom[he data is stored or to be stored shall be as set forth in this secrion. Subd.2. Information reqtrired to be given individual. An individual asked to suppiy private or confidenrial data conceming himself shall be informed of: (a)the purpose and in[ended use of the requesied data wichin the collecting"state agency,polirical subdivision,or statewide rystem; (b)whether he may refuse oi is legally required to suppty the reques[ed data;(c)any lrnown consequence arising from his supplying or refusing to suppiy private or confidentiai data;and(d)the idenrity of other persons or enuaes au[horized by state or fedenl law to receive the data. This requirement shall not apply when an individual is asked[o supply investieaove dara, pursuanc to secaon 13.82,subdivision 5, to a law enforcement o�cer. The commissioner of re�enue mav place the norice reauired under this subdivision in the individual income tax or propertV tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upon requesc to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whecher 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 che data wi[hout any charge to hun and, if he desires, shall be informed of the content and meaning of that data. After an individual has been shown[he private data and informed of its meaning.che data need not be disclosed to him for six months thereafter unless a dispute or acdon pursuan[to this secoon is pending or addidonal data on the individual has been collected or created. The responsible authority shali provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the acmal cosu of making. certifying, and compiling rhe copies. The responsible authoriry shall compiy immediately, if possible, with any reques[made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immedia[e compliance is not possible. If he cannot comply with the requesc within that time,he shall so inform[he individual,and may have an additional 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 pri��ate data concerning himself. To exereise this right,an individual shall nqtify in writing the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either. (a)correa the data found to be inaccurate or incomplete and attempt to nodfy past recipienrs of inaccumte or incomplete data, including recipients named by che individual; or(b)notify the individual thac he believes the data to be correcc. Data in dispute shall be disc(osed only if the individual's statement of disagreement is included with the disclosed data. The determination 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 deternune your qualification for the pemut or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the pemvt 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 permit or license requires Council action to approve, some information may become public. 5. You have cenain 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. � s Y�-� � �'�- f�.�� First vtiddle Last 5�4 7 .r L /� vt�o,c� Q �P Address \ � � N �p� �� Ss3 � +� City Stare Zip Phone I understand my rights stated ab e. Signature