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a � 7 . .. ' � � Sea 13.04 RIGFITS OF SLTBJECTS OF DATA � Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth ia this secdon. Subd.2. Information required to be given individual. Aa individual asked to supply private or confidendal data concerning himself s�aII be informed of: (a)the puipose and intended use of the requested data within the collecting state agency,polidcal subdivision, or statewide system:�b) whether he may refuse or is legally required to supply the requested data; (c)any known consequence arising from his supplying or refusing to�cfy private or confidential dara;and(d)the idenuty of other persoos or endties authorized by srate or federal law to receive the data. This requirement s�all not apply when an individual is asked to supply invesdgaave data,pursuant to section 13.82, subdivision 5, to a law enforcement officer. The commissioner of ievenue mav vlace the notice requued under tfus subdivision in the individual income raz or�rovertv tax refund insuuc�crs instead of on those forms. S�bd.3. Accea to data by mdividual. Upon request to a responsible authority, an individual shall be informed whether he is the subject of stoied data on individuals,az�d whether it is clas.rified as public,private or confidendal. Upon his further request,an individual who is the subject of smr..3 private or pub(ic data on individuals shall be shown the dara without any charge to hun and, if he desires, shall be informed of the content and mean�3 of that data. After an individual has been shown rhe private data and informed of its meaning, the dara need not be disclosed to him for siz mo�s thereafter utiless a dispute or acrion pursuant to this secdoo is pending or addirional data on the individual has been collected or created. The respoas�le authority shall provide copies of the private or public dara upon request by the individual subject of the data. The responsibte authority may requi��e requesting person to pay the actual cosu of malcing, certifying, and compiling the copies. The cesponsible authority shall comply immediately, if possible, with any request made pursuant to this subdivision, or within five days oi�e date of the cequest,ezcluding Saaudays,S�u�days and legal holidays, if immediate compliance is not possible. If he cannot comply with the request R�in that ame,he shall so inform the individual, and may have an additional five days within which to comply with the request, excluding Saturdays, Sun'ays and legal holidays. Subd.4. Procedure when data is noi accurate or complete. An individual may contest the accuiacy or completeness of public or privare daia wnceming himself. To ezercise this right,an individual shall nodfy in writing the responsible authority describing the nature of the disagreement 'fhe cesponsible authoriry shall within.i0 days either. (a)corcect the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of inaccunre or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the dara to be correct. Data in dispute sball be disclosed only if the individual's statement of disagreement is included with the disclosed data. The detemunaaon of die responsible authoriry may be appealed pucsuant to the p�ovisions of the adminis�adve procedure act relating to contes._.� 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 fumish certain private or confidential information. You are notified that: 1. The information you fumish will be used to determine your qualification for the permit or license request�d. 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 righu 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. Z✓/ C-�/Q��/cF! First Middle Last 3�SO '�"'�"qr(�2 jn'yc}� L/%3�.E Address �t��✓��Ta�� ,,,,�,,,,F 5'S3p 5' �i 3� —�,� Ciry State Zip Phone I understand m rights as stated above. Signature 10