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Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. T'he rights of individual on whom the data is stored or to be stored shall be as set forth in this secaon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal data conceming himself shall be utformed of: (a) the purpose and intended use of the requested data within the coilecting'state agency,polidcal subdivision,or sratewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply � priva[e or confidenrial data;and(d)che idendty of other pzrsons or enudes au[horized by stare or federal law to receive the data. This requirement shall not appiy when an individual is asked to supply invesrieaave dara, pursuant to seccion 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 or propertv tax refund instruccions inscead of on those forms. Subd. 3. Access to data by individual. Upon reques[to a responsible authority,an individual shall be informed whether he is the subject of scored data on individuals,and whe[her it is classified as public, priva[e or confidential. Upon his further request, an individual who is the subject of stored private or pubiic data on individuais shall be shown che data wichout any charge to hun and, if he desires, shall be informed of the contenc and meaning of that data. Afrer an individual has been shown the priva[e data and informed of its meaning,t1�e data need no[be disclosed to him for six months thereafter unless a dispute or acdon pursuan[to this secnon is pending or addidonal data on the individual has been collzcted 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 requesring person to pay the actual costs of makinz, certifying, and compiling rhe 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 not possible. If he canaot comply with the request within that time,he shall so inform the individual,and may have an addi[ional 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 conceming himself. To exercise[his right,an individual shall noafy in wriang 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 recipienu of inaccunte or incomplete data, including recipiencs named by the individual; or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disciosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsibte authoriry may be appealed pursuant to the provisions of the administrarive procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "Ri�hts of subjects of data", we would like to inform you that your request for a permi[ 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 a�encies to the extent necessary to process the pernut or license. 4. If your requested permit or license requires Council action to approve, some informa[ion 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. `/r, � L ia n� /�!a ��C� � ' � _!-� First Middle Last � / � ��c�iz� lt � r- Address ' �I �1� �� c� 4 � �" �� �(�t-1 n -� > > � Ciry �—# , � ~ State Zip Phone I understand my rights as stated above. �. �./�;-i � Signaprte C