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Sec.13.0�1 RIGHTS OF SUBJECTS OF DATA 5ubd. L Type of data. The righu of individual on whom the data is srored or to be stored shall be as set forth in this section. Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himselfshall be informed of: (a)the purpose and intended use ofthe requested data within the collecting state agency,political subdivision,or statewide system;(b) whether he may refuse or is legally required to supply the requested data;(c)any kno��n consequence arising from his supplying or refusing to supply private or confidential data;and(d)the identiry ot other persons or entities authorized by state or federal la�v 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 officer. The commissioner of revenue ma�place the notice required under this subdivision in the individual income tae or properry tae refund instructions instead of on those forms. Subd.3. Access to data by individuaL Upon request to a responsible authoriry,an individual shall be informed whether he is die subject of stored data on individuals,and whether it is classitied as public,private or confidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shafl be shown the data wid�out any charge to him and,if he desires,shall be infonned ofthe content and meaning of dlat data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereatter w�less a dispute or action pursuant to this section is pending or additional data on the individual has been col(ected or created. The responsible authority shall provide copies of d1e private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the actual wsts of making,certitying,and compil ing[he copies. The responsible authority shal I comply immediately,if possible,with aity request made pursuant to this subdivision,or widiin tive days of the date ofthe request,excluding Saturdays,5undays and legal holidays,if immediate compliance is not possibfe. Ifhe cannot comply with the request �vidiin that time,he shall so inform the individual,and may have an additional tive days within which to comply with the request,ezcluding Saturdays, Sundays and legai holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature ofthe disagreement. The responsible authority shall within 30 days 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)notity the individual that he believes dle data to be correct. Data in dispute shail be disclosed only if the individual's statement of disagreement is included with the disclosed data. The detennination ofthe responsible authoriry may be appealed pursuant to the provisions of the administrative procedure act relating to contested cases. DATA PRNACY ADVISORY In accordance with M.S. 13.04,Subd.2, "Rights of subjects ofdata",we would like to inform you that your request for a pennit 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: 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 refusa(may require that the City deny the permit 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 ri�hts 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. Fir Middlc Last ��Y�-�g J I�A — • 1 _ _� r/ / ��y7 i�(�dfC$S � � � .�r�8 � Citv�� StAt�A �\ZiP ��e �/ � �O�V ��j � � ,�� '\�\ � I understand my rights as stated above. � �- v,�� Sinnature .i?