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Sec.13Ad RIGH"I�S OF SCB.IECTS OF DATA Subd I. 'I ype of data. 'The rights of individual on whom the data is stored or to be stored shall be as sel forth in this section. Subd.2. Information required to be eiven indi�idual. An individual asked to supply private orcontidential data concemin2 himseH�shall be infonned of: (a)the purpose and intended use of the requested data within the collecting state agency.political subdivision,or statewide system:(b) �chether 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 dala. This requirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision�,to a law enforcement officer. The commissioner of revznue mav qlace the notice reauired under this subdivision in the individual income ta�or propertv ta�refund instruc[ions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the suhject of stored data on individuals,and whether it is classified as puhlic,private or confidential. Upon his further requ�st,an individual who is the subject of stored private or publ ic data on individuals shall be show�n the data without any charge to him and,if he desires.shall be informed of the content and meaning of that data After an individual has been shown the private data and informed of its meaning.the data need not be disclosed to him ibr six months thereatter unless a dispute or action pursuant to this sectiai is pending or additional data on the individual has been col lected or created 'Che responsible authority shall provide copies ol the private or public data upon reyuest by the individual subject ofthe data. T'he responsible authoriry may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. I'he responsible authority shall comply�immediatelv,ifpossible,with any request made pursuant to this subdivision.or within five da��s of the date ofthe reyuest,excluding Saturdays.Sundays and legal holidays,if immediate compliance is not possible. Ifhe cannot comply�vith the request within that time,he shall so inform the individual,and may have an additional tive davs within�ifiich to comply with the request,e�cluding Saturdays, Sundays and legal holida}s. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of publ ic or private data concerning himself. To esercise this right,an individual shall notif�in writing the responsible authority describing the nature ofthe disagreement The responsible authority shall within 30 day�s either (a)correct 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)notifj'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 determination of lhe responsible authority may be appealed pursuant to the provisions ofthe 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 fi�om the City of Orono or any of its departmenLs may require you to furnish certain private or confidcntial information. You are notitied that: L The information you furnish will be used to determine your qualitication for the permit or license requested. 2. You may refuse to supply data,but refusal may rcquire that the City deny�the permit or license. - 3. �I�he information may be shared �vith other local. state or federal agencies to the ertcnt 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 dala on yourself. 6. Your full name is required to process this application or permit. First Middle Last /� G.l��-� �.✓�✓ ��.f.'C./�� ,Add ress ��t.�� Fic�U�ltvV & REMnn€61N6;-1P�^ 4�100 EXCELSIOR BLVD. c�ty "�T- I._i�UIS PARK, MN ��4�� sta�e z�� Nno�e I understand my rights as stated��Q105(� ��-- %li�-- ��___ _ Signature v Reset Form 32