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N ' � Sec.13.04 RIGHTS OF SUB,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 for�in this section. Subd.2. Information required to be given individual. An individual asked to supply private or confidential data conceming himself shall be infocmed of: (a)the purpose and intended use of the requested dara wichin the collecting srate agency,political subdivision,or sratewide system; (b) whether he may refuse or is legally required to supply the requested data;(c)any imown consequence arising from his supplying or refusing to supply private or confidendal dara;and(d)the idendty of other persons or endues authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data, punuant to section 13.82, subdivision 5, to a law enforr,ement officer. 'il�e commissioner of�evenue mav olace the notice�equimd under this subdivision in the individual income taz or nroperty tax refund instructions insuad of on those forms. S�bd.3. Acces to data by mdividual. Upon request t0 a responsible authoriry, an individual shall be informed whether he is the subject of stomd data on individuals,and whether it is classi5ed as public,private or confide�dal. Upon his further request, an individual who is the subject of stored private or public data on individuals shall be shown the dara without any charge to hun and, if he desires, shall be informed of the content and meaning of that data. After an individual 6as been shown the private data and informed of its meaning, the dara need not be disclosed to him for siz months theteafter unless a dispute or acaon pursuant to this section is pendiqg or addidonal data on the indi'vidual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual cosu of making,certifying, and compiling the copies. The cesponsible authoriry shall comply,immediately, if possible,with,any,request made punuant to this subdivision, or within five days of the date of the tequest,excluding Samrdays,Stiu�days 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 6ave an addidonal fi��e days within which to compiy with the request, ezcluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. ,�a mdividual may confest the accuracy or completeness of public or private data conceming himself. To ezercise this right,an individual shall nodfy in wTiang the responsible authoriry describing the naaue of the disagreement. The responsible authority shall within 30 days either. (a)cnrrect the data found to be inaccurate or incomple;e and attempt to noafy past recipienu of inaccurate or incomplete dara, including recipienu named by the individual; or(b)norify the individual that he txlieves the data to be correct. Data in dispute shall be disclosed orily if the individual's statement of disagreement is included with the disclosed data. The detemunaaon of the cEsponsible aut�oriry may be appealed punuant to the provisions of the administrative procedure act relating ro 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 pemut 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 fumish 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 s�ared 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 righu 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. � ,T�"FF RE Y �}�.A�v �°�P�Q'u S First Middle Last 6 ss/ oRc�/b L�+ti6 �►�4»� Address ti!A'P�� G,4 ov� �►d✓ .�� 6/2 �ss3•isz� Ciry State Zip Phone I understand righ as above Signature 10