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� Sec.13.04 RIGHTS OF SIJBJECTS OF DATA Subd. 1. Type of data. The righ[s of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal data concerning himself shall be informed of: (a)the purpose and inteoded use of the requestcd dara within the collecang'state agency,poliacal subdivision,or sratewide sysum; (b)whecher he may refuse oY is legally required to supply che requested data;(c)any�own coasequence arising from his supplying or refusing to supply private or confidendal data;and(d)the idendry of other pecsons or enriues authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesrigadve dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of revenue mav place the nodce reauired under chis subdivision in the individual income rax oc oropectv taz refund instrucdons ins[ead of on those forms. Subd. 3. Access to data by indiridual. Upon request to a responsible authoriry,an individual shall be informed whethec he is the subject of stored data on individuals,and whe[her it is classified as pubiic, private or confidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the da[a without any charge to him and,-if he desires, shall be informed of the content and meaning of[hat data. Afrer an individual 6as been shown the private data and informed of its meaning,the data need not be disclosed to trim for six months thereafter unless a dispute or action pursuant to [his secrion is pending or addidonal dara on the individual has been collected or created. The responsibie authoriry shall provide copies of the private or public data upon request by the individual subject of the daca. The responsible authoriry may require the requesting person to pay the ac[ual cosu of making,certifying,and compiling the copies. The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision,or wi[hin five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possibie. If he cannot comply with the request wi[hin that dme,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 individual may contest the accuracy or completeness of public or pri�•ate data conceming himself. To exercise this right,an individual shall noafy in wricing the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurau or incomplete and attempt to nodfy past recipienu of inaccurate or incomplete data, including recipients named by the individual; or(b)nodfy the individual that he believes the data to be correcc. Data in dispute shall be disclosed only if the individual's statemenc of disagreement is included with the disclosed data. The determinaaon of the responsible authority may be appealed pursuanc to the provisions of the adaunisaadve 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 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 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 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 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. �6�a.:� .,:, �J.�1�11 Lk� First Middle Last l v�� c�� 2 S �`�'1 Address ��> >�n� �,��3�� aJ ��-ol � Ciry State Zip Phone I understand my rights as stated above. �`�./`...�'� �,.�c�'�-Q�1 Signamre