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Sec.13.04 RIGHTS OF SUBJECTS OF D�TA Subd. 1. Type of data. The rig6ts of individual on whom rhe data is stored or co be stored shall be as se[forrh in rhis secdon. Subd.2. Informatioo reqirired to be given individual. An individual asked to supply private or confidenaal data conceming himself shall be informed of: (a)the purpose and ia[ended use of the requesied data wi�hin the collecang'statP a2ency,political subdivision,or sratewide system; (b)whether he may refuse or is legally required to suppty the reques[ed data:(c)any lrnown consequence arising from his supplying or refusing to supply private or confidenrial data;and(d)the idenri[y of other persons or ennoes au[horized by state or fed:rai law to receive the data. This requirement shall not apply when an individual is asked to supply invesdeauve daca, pursuan[to secrion 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of re�enue mav place �he notice reouired under this subdivision in the individual income_tax or propertv tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upon requesc to a responsibte au[horiry,an individual shall be informed whether he is the subject of scored data on individuals, and whe[her it is classified as public, private or confidenrial. Upo�his further request,an individual who is the subjec� of stored private or public data on individuals shall be shown[he data wichout any charge to hun and, if he desires, shall be informed of the content and meaning of[hat data. After an individual has been shown the private data and informed of ics meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acdon pursuan[to this section is pending or addinonal dara on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon requesc by the individual subject of the data. The responsible authority may require the requesring person to pay the actual costs of making, cerafying, and compiling the copies. The responsible authoriry shall comply immediately, if possible, with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is no[possible. If he cannot comp(y with the request within that time,he shall so inform the individual,and may have an addivonal five days within which w comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of pubiic or pm•ate data concerning himself. To exercise[his rieht,an individual shall notify in wricing[he responsible authoriry describing the nature of the disagreemen[. The responsible authoriry shall within 30 days either: (a)correct the data found ro be inaccurate or incomplete and attempt to nodfy past recipienu of inaccucate or incomplete data, including recipiencs named by the individual; or(b)norify 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 determinaaon of the responsible authoriry may be appealed pursuan[to the provisions of the administrarive procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd.2, "Rights of subjects of data", we w�ould 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 fumish certain private or confidential information. You are notified that: 1. The information you furnish 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 locai, state or federal a�encies to the extent necessary to process the pernut 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 application or permit. � / -��✓ �'��G �' ,_S�f �� 1 First Middl �t „? ?GI , • Address S�� '�� ad r� /�'� '� .�-�'(� G� ��/� ��'�9� y 3�"� City Stare Zip Phone I understand my ri hts ated ab e. - � ,;� �, � Signature