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i Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or Lo be stored shall be as set forth in this section. Subd.2. Infonna[ion required to be given individual. An individual asked to supply piivate or confidential data conceming himseif shall be infonned oE (a)the purpose and intended use of the requested data wi[hin the collecting state a�ency,poiitical subdivision,or statewide system;(b) whether he may refuse or is legally required to supply dle requested data;(c)any known consequence arising from his supplying or refusing to supp(y priva[e or confidential data;and(d)the identity of other persons or enticies authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data,pursuan[[o section 13.82,subdivision 5,to a law enforcement ofticer. The commissioner of revenue may place the notice required under this subdivision in the individual income tar or prooeitv tax refund instructions instead of on those fonns. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be infonned whether he is the subject of stored data on individuals,and whether it is classitied as public,private or contiden[ial. 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 inYonned of the content and meaning of that data. After an individual has been shown the private data and infonned of its meaning,the data need not be disclosed to him for six months thereal4er unless a dispute or action pursuant to diis section is pending or additional data on the individual has been collected or created. The responsible authority shall provide copies ofthe privlte or public data upon request by the individual subject ofthe data. The responsible authoiity may require the requestine person to pay the actual costs of making,ce�tifying,and compiling the copies. The responsible au[hority shall comply immediately,if possible,with any request made pw�suant to this subdivision,or within five days ofdie date of�the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. [f he cannot comply with the requcst wi[hin tha[time,he shall so infonn the individual,and may have an additional live days within which to comply with Ihe request,exduding Saturdays, Sundays and leeal holidays. Subd.4. Procedure when data is not accurate or complete. An individuai�nay contest the accuracy or completeness of public or p�ivate data conceming himself. To exercise diis right,an individual shall notity in writing the responsible authoiity describing the nature ofthe disae�eement. "l�he responsible authoiity shall within 30 days either: (a)con�ect 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)notity the individual tha[he believes the data lo be con ect. Data in dispute shall be disclosed oniy if the individual's statement of disag�eement is included with the disclosed data. The detenninition of the responsible authority may be appealed pursuant to the provisions of the administ��ative procedure act relating to coniested 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 perniit or license from the City of Orono or any of its departments may require you to furnish certain private or confidential inforniation. You are notified that: 1. The infonnation you furnish will be used to detennine your qualification for the permit or license requested. 2. You may refuse to supply data,but refusal may require that the City deny the pernlit 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 a lication or pernut. �'W'�-�.JC '�� Z��.�`�-c � First Middle Las[ �� Address City Statc Zip Phone I understand my righ s stated above. �• at re 32