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Sec.13.04 RIGHTS OF SUBJECTS 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. [nfonnation requu�ed to be given individuaL An individual asked to supply private or confidential data concerning himself shall be infonned of: (a)the purpose and intended use of the requested data within[he collecting state agency,political 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 supply private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement ofticer. The cotnmissioner of revenue mav place the notice reauired under this subdivision in the individuai income tax or prope�tv tax refund instructions instead of on those fonns. Subd.3. Access to data by individual. Upon request to a responsible authority,an individua�shall be informed wbether he is the subject of stored data on individuats,and whether it is c(assified as public,private or confidentiaL Upon his further request,an individual who is[he subjc�:t of stored private or public data on individuals shall be shown the data wi[hout any charge to him and,if he desires,shall be infortned of the content and meaning of that data. After an iodividual has been shown the private data and infonned of its meaning,Ihe data need not be disclosed to him for six months thereafter unless a dispute or action pursuant ro this section is pending or additional data on the individual has been collected or created. The responsible authority shall provide copies of the piivate or public daca upon request by the individual subject oY[he data. The responsible authority may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Satw�days,Sundays and[egal holidays,if immediate compliance is not possible. If he cannot comply with the requcst within that time,he sha(1 so infonn[he individual,and may have an additional tive days within which[o comply with the request,excludino 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 piivate data conceming himselE To exercise this iight,an individual shall notify in writing the responsible authority describing the nature of the disagreemenL "Ihe responsible au[honry shall within 30 days ei[her. (a)correct the data found to be inaccurate or incomplete and attempt to notify pas[recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The detennination of'the responsible au[hority may be appealed pursuant to the provisions of the adminishative procedure act relating to contested cases. DATA PRNACY 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 information. You are notified that: l. The information you fumish will be used to determine your qualification for the pemiit or license requested. 2. You may refuse to supply data,but refusal may require that the City deny the permit or license. 3. The infonnation 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 appiication or pennit. j��'��,/J J �c.�.�,�i'�� Firsi Middle Last �-/f�(b �U ti/�/C� ��d�.T Address ��l�.! �r"�t "i<- Yl�.r� S�`f 7 City � Statc Zip Phone � / � I understaryl y riDhts as stated+,a#f :/ / / .�---� �,/':.:-= Sign ure