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Sec.13.04 RIGHTS OF�UBJECTS OF DATA Subd. 1. Type of data. The righcs of individual on whom die data is stored or to be stored shall be as set forth in this section. Subd.2. Information required to be given indi��dual. An individual asked to supply private or confidential data concerning himself shall bz informed of: (a)the pui7wse and intended use of the requesced data within the collecting state agency, poli[ical subdivision, or statewide system;(b)whether he may refuse or is legally required ro supply the requested data; (c)any known consequence arising from his supplying or refusing to supply private or co�dential data;and(d)[he identiry of other persons or entities aud�orized by state or federal law ro receive the data. This requirement shall not apply when an individual is asked ro supply investigative data, pursuant to section 13.82, subdivision 5, to a law enforcement officer. The commieeioner of revernie mav olace the notice required under this subdivision in the individual income tax or propertv tax refund instructions instead 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[he subject of stored data on individuafs, and whether it is classified as public, 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 data without any charge to hirn and, if he desires, shall be informed of the content and meanino of[hat data. After an individual has been shown the private data and informed of its meaning, the data need not be disclosed to him for six months thereafrer unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public dara upon request by the individual subject of the data. The responsible authority may require the requesting person to pay die actual costs of making, certifying, and compiling the copies. The responsible authoriry shall comply inunediately,if possible,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 cannot comply wich the request within that time, he shali so inform the individual, and may have an additional 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 concerning himself. To exercise this right,an individual shall notify in writing the responsible au�horiry describing the nature of the disagreement. The responsible a�thoriry shall widtin 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data, including recipients named by the individual;or(b)notify the individual that he believes the data ro be correct. Data in dispute shall be disclosed only if the individual's statemen[of disagreement is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrative 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 �ity 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 reques[ed. 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. ��n wi�c�-. -F�.��i-rr�s f�.�-� d�� First Middle Las� ,3�3 so ��TM S7— ►� �—� Ad ress .s �� '�� 3 7� ��3z� Ciry State Zip Phone I nderstand y rights s st ove. Sig r 6