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Sec.13.04 RIGHTS OF StiBJECTS OF DATA Subd.1. Type of data. The rights of individual on whom the data is stored or to be stored shail be as set forth in this section. Subd.2. In[ormation required to be given individual. An indi�idual asked to supply private or confidentlal data concerning himtelf shall be informed o[: (a)the purpose and intended use of the requested data within the collecting state agency,political sabdivision,or statewide s}-siem;(b) whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplyin;or refusing to supply private or confldential data;and(d)the identity of other persons or entities authorized by state or federal law to recrir e the data. This requinment shall not apply when an individuai is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a l�w enforcement officer. The commissioner o[revenue mav lace the notice re uired under this subdivision in the individual income tax or ro ertv taz refund instructions instead of on those forms. Subd.3. Access to data by individual. lipon request to a respoosibie aut6ority,an individual shall be inlormed whether he is the sabject of stored data on individuais,and whether it is classified as pubiic,pricate or confidendal. lipoo 6is further request an individual who it the svbject o[ stored private or public data on individuals shall be shown the data without any cha se to him and,if he desires,shall be informed of the content and meaning of that data. After an individuai has been shown the private data and inCormed of its meaning,the dau oeed not be disclosed to him for six months thereafter unless a dispute or action pursuant to this section is pending or addirional data on the individual has been collected or created. The responsible authority shall provide copies of the private or public data upon request b}-the individual subject of the data. T6e responsible authoriri-may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authority shall comply immediately,itpossible,w ith any request made pursuant to this s�bdivision,or w ithin five da}�of the date of the request,excluding Saturdays,Sundays and legal holidays,i[immediate compliance is not possible. If he annot rnmpl}�with the requeu within that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,eacludin;Saturdays,Sundays and legal holida}•s. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness o(public or prn-ate data concerning himself. To exercise this right,an individual shall notify in writing the respoosible authorih�describin;t5e nature of the disagrtecnen4 The responsible authority shall within 30 days either: (a)correct the data tou�d to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notlf��the individual that he beL'eves the data to be correct Dsta in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the administrati�e procedure act relaone to contested cases. DATA PRIVACY AD�TSORY In accordance with 1�1.S.13.04,Subd.2,"Rights of subjects of data",�ve would like to inform}•ou that�-our 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}-our 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 federa!agencies to the estent necessar�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 1�I.S. 13.0�3(a��ailable upon request)to review private data on}-ourself. 6. Your full name is required to process this application or permit. � � M/� !�t /(�f li1� � First �Lddle Last � 6 S 1� . (-e�2N D.n-�..� t�� Address �'`� n./ S �39 9S2 �f 7� �,ty State Zip Phone I understand my rights as stated above. . � Signature