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� . Sec.13.Od RIGHTSOFSUBJECTSOFDATA � Subdivision 1. Type of data. The rights oJindividual on whom the data is stored or to be stored shal!be as set jorth in this section.� " Subd.2. Information required to be given individuaL An rndividual asked to supply private or confidential data concerning himself shall be informed of. (a)the purpose and intended use of the requested data wilhin the collecting state agency,politrcal subdivision,or statewide system;(b)whether he may refuse or rs lega!!y required to supply the requested data;(c)any known consequence arrsing from hrs supplyrng or refusing to supply private or confrdential data;and(d)the identity of other persons or entities authorized by state orfederal law to receive the data. This requirement shall not apply when an indivrdual is asked to supply invesligative data,pursuant to section /3.82, subdivisron 5, to a law enforcement offrcer. The commissioner o(revenue may place the notice required under this subdivision in the indrvidual income tar or property tax refund instructions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual sha/1 be injormed whether he is the subject of slored data on indrviduals, and whether it is classified as public,private or confrdential. Upon his further request,an individua!who is the subject ojstared private or public data on individuals shal!be shotivn the data without any charge to him and, if he desrres,shall be informed oj the content and meaning oJrhat data. After an indivrdua!has been shoivn the prrvate data and rnformed of its meaning, the data need not be disclosed to him for six months thereafter unless a dispute or actron pursuant to thrs section is pendrng or additiona!data on the indivrdual has been collected or created. The responsible authoriry shall provide copies ojthe private or public data upon request by the individual subject of the data. The responsrble authority may require the reguestrng person to pay the actual costs ojmaking,cert�ing,and compiling the copies. The responsible authorrty shall comply immediately,rfpossi6le,tivith any request made pursuant to lhis subdivision,or tivithin five days of the date of the request,excluding Saturdays,Sundays and legal holidays,rf rmmedrate compliance is not possible. Ijhe cannot comply with the request tivithin that time,he shall so inform the rndrvidual,and may have an additional five days lvithrn�vhich to comply tivith the request,excluding Saturdays,Sundays and lega!holidays. Subd.4. Procedure when data is not accurate or complete.An rndrvidual may contest the accuracy or completeness ofpt�blic or private data concerning himselj. To exercise this right, an individual shal!nol�in writing the responsible authorrty describrng the nature of the disagreement. The responsrble authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past reciprents of inaccurate or incomplete data,inc/uding recipients named by the individual;or(b)not�the individual that he believes the data to be correct. Data in drspute shall be disclosed only rf the indivrdual's statement of drsagreement rs rncluded wrlh the disclosed data. The determination of the responsi6le authority may be appealed pursuant 10 the provisions of the administrative procedure act relating to contested cases. DATA PRIVACYADV/SORY In accordance tivrth M S.13.03,Subd.2, "Rights ofsubjects ofdata",ive would like to inform you that yaur requestfor a permit or license from the City ojOrono or any of its departments may reguire you to furnish certain private or confidentia!rnformation. You are notified that: 1. The information you furnish will be used to determine your qualifrcation for the permit or license requested. 2. You may refuse to supply data,but refusal may requrre that the City deny the permit or license. 3. The information may be shared with other local,state or,jederal agencies to the extent necessary to process the permit or license. 4. If your requested permrt or license requires Councr!aclron to approve,some informatron may become public. S. You have certain rights under M.S. 13.04(see following page)to revieiv private data on yourselj. 6. Your full name rs required to process this application or permit. PLEASE PRINT � �cC.`CSU`� / " � C�- v��CCF.SU�'� First Middle Last �u ( s �� rl� s� Address �V1C��'�,c� /�/�/L� S�� ,l l City State Zip Phone �( �^�-�� 'd�(J �. I u �rst nd my ri a e a ove. �ls -1 � G(j�� (,( �f�, I l �� Si n ur .--�" /0