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.� a Sec.13.04 RIGHTS OF SLJBJECTS OF DATA Subd. 1. Type of data. The righu of individual on whom[he data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. M individual asked to supply private or confidendal data concerning himself shall be informed of: (a)the purpose and intended use of che requested data within the collecting"state agency,polidcal subdivision,or statewide system; (b)whether he may refuse ot is legally required to supply the requested data;(c)any Irnown consequence arising from his supplying or refusing to supply priva[e or confidencial data;and(d)the idenriry of other persons or enrities au[horized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invescigarive dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of r��enue mav place the noace required under this subdivision in the individual income tax or proper[v tax refund instructions instzad of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals, and whecher i�is classified as public, private or confidenrial. Upon his further request, an individual who is the subject of stored private or public data on individuals shali be shown the data without any charge to him and, if he desires, shall be informed of the content and meaning of[hat data. Afrer an individu�l has been shown the private data and informed of its meaning, the data need not be disclosed to him for six months[hereafrer unless a dispute or acrion pursuant to this secaon is pending or additionai data on the individual has been collected 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 requesting person to pay the acrual cosu of making, cerafying, and compiling the copies. The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision, or within five days of the date of the request,excluding Sa[urdays,Sundays and le¢al holidays,if immediate compliance is not possible. If he cannot comply with the request within that tune,he shall so inform the individual,and may have an addirional 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 individua(may contest the accuracy or completeness of public or pri�•ate data concerning himself. To exercise[his rieht,an individual shall notify in writing the responsible au[horiry describing rhe nature of the disagreement. The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past tecipients of inaccurate or incomplete data, including recipients named by[he 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 wi[h the disclosed data. Ttie decerminarion of the responsible authority may be appealed pursuanc to the provisions of the administrarive 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 determine your qualification for the pemut or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the pemut or license. 3. The information may be shared with other local, state or federal agencies 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. First Middle Last Address Ciry State Zip Phone I understand my rights as stated above. i��/�7/� —T Signacure/