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Scc.13A4 RIGtITS OF SUBJGCTS 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 in this section. Subd.2. Infonnation required to be given individual. An individual asked to supply private or confidential data concerning himselfshal I be int'onned of: (a)the purpose and intended use of the requested data�>�ithin the collecting state aeency,political subdivision,or statewide system;(b) ��hether he may refuse or is legally required to supply the requested data;(c)any kno�vn consequence arising from his supplying or refusin�to supply private or contidential data;and(d)the identity of other persons or entities authorized by state or federal la�v to receive d�e data. This requirement shall not apply when an individual is asked to supply investigacive data,pursuant to section 13.82,subdivision�,to a law enforcement ofticer. The commissioner of revenue mav place the notice required under this subdivision in the individual income ta�or propertv ta�refund instructions instead of on those tbrms. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shal I be infonned whether he is the subject of stored data on individuals,and whether it is dassitied as pubiic,private or contidential. 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 him and,if he desires,shall be informed of the content and meaning of that data. Atter an individual has been shown the private data and infonned of its meaning,the data need not be disclosed to him tor six months thereatter unless a dispute or action pursuan[to this section is pendin�or additional data on the individual has been collected or created. The responsible authority shall provide copies of the privace or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual costs of making,certitying,and compiling the copies. The responsible au[hority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within tive days of the date ofthe request,e�duding Saturdays,Swidays and legal holidays,ifimmediate compliance is not possiUle, If he cannot comply with the request within that time,he shall so inform[he individual,and may have an additional tive days within which to comply with the request,esdudine Saturd�ys, Stuidays 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 himselti. To exercise this right,an individual shalf nocity in�<<ritin�the responsible authority describing the na[ure of the disagreement. The responsible authority shall�vithin 30 dlys either. (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,induding recipients named by the individual;or(b)notify the individual that he believes ehe data fo be correct. Dafa in dispute shall be disclosed only if the individual's statement 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 City of Orono or any of its departments may require you to furnish certain private or confidential infonnation. You are notified that: 1. The infonnation you fw•nish 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 rec�uested permit or license requires Council action to approve, some information may become public. 5. You have certain ri�hts w�der NLS. 13.04 (available upon request)to review private data on yourself. 6. �'our full name is required to process this application or pennit. Eirst i�[iddlc L:�st .�ddress Cit}• State Zip Phone I understand mv ri�hts �ted above. Sicnatu c Reset Form 3?