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Scc.13.0�1 RIGE[TS OF SUSJECTS OF DAT:� 3ubd. l. Type of data. The rights of individual on whom tlle data is stored or to be stored shall be as set forth in this section. SuUd.2. Information required to be given individual. An individual asked to supply private or contidential data concerning himselfshalf be intbrmed of: (a)the pu�pose and intended use ofthe reques[ed data within the collecting state agency,political subdivision,or statewide system;(b) ��Itether he inay refuse or is legally required to suppiy the requested da[a;(c)any known consequence arising from his supplying or reftisin�to supply private or confidential data;and(d)the identity oFother persons or entities auchorized by state or federal Iaw to receive the data. This requirement shal I not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue mav olace the no[ice rec�iired imder this subdivision in the individual income ta�qr r�opertv tas refund instructions instead of on those forms. Subd.3. Access to data by individuaL Upon request[o a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and�vhethzr it is classitied as public,private or confidentiaL Upon his furtller request,an individual who is the subjcct of stored private or public data on individuals shall be sho«n the data wi[hout any charge to him and,if he desires,shail be informed ofthe content and meaning of that data After an individual has been shown the privare data and inFormed of its meaning,the data need not be disclosed to him for sis months thereafter unless a dispute or action pursuant ro this section is pendin�or additional data on the individual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible aufhority may require the requesting person to pay the actual costs ofmaking,certityine,and compiling the copies. The responsible authority shall compiy immediately,if possible,with any request made pursuant to this subdivision,or within tive days of the date ofthe request,ezcluding Salurdays,Swldays and legal holidays,if immediate compliance is not possible. [fhe cannot comply wid�the request within that Iime,he shall so inform the individual,and may have an additional five days within which ro comply with the requesc,escl�idin2 Saturdays, Sundays and legal holidays. 5 ubd.4. Procedure when data is no[accurate or complefe. An individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this ri�ht,an individual shall notify�in writing the responsibie authoriry describing the nature of the disagreement. The responsible authority shall��ithin 30 days eithec (a)correct the data found to be inaccurate or incompiete and attempt to notif�-past recipients of inaccurate or incomplete data,including recipients named by the individual;ar(b)notify the individual that he believes the data to be carrect. Data in dispute shall be disclosed only if the individual's statement of disagreement is included�vith the disclosed data. The determination of the responsibie authority may be appealed pursuan[to the provisions of the administrative procedure act relating to contested cnses. 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 depar[ments may require you to furnish certain private or confidential information. You are notified that: 1. The information you furnish will be used to dete�mine your qualification for the permit or license requested. 2. You may refuse to supply data, btit refusal may require that the City de�ly the permit or license. 3. The information m1y be shared �vith 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 inforn�ation may becoit�e public. 5. You have certain rights under 1�1.S. 13.04 (availablz upon request)to revie��•private data on yourself. 6. 1'our full name is required to process this application or permit. � �, .� , First �'liddlc L:ist :�ddress Citv Staic 7_ip Phone n I understand m�� rirhts as stated abo�e.� � ��.,,..._.__.J� � ' - ��C.�f��_�------ �C C--� l�� Sign;iturc , Reszt Farm ��'