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Scc.13.04 RIGHTS OF SURJECTS OF DATA ' � Subd.1. Type of data. Thc rights of individual on whom the data is stored or to be stored shall be as sM forth in this section. Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himsclf shall bc intormed of: (a)the purpose and intended use of thc requested data�vithin the collecting state agency,political subdivision,or statewide system;(b) whethcr he may refusc or is Icgally requircd to supply the reyuested 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 data. This requirement shall not apply when an individual is asked to supply investigative data,pursuant to scction 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue ma�� nlace the notice required under this subdivision in the individual income taz or propertv tax refund instructions instcad of on thosc forms. Subd.3. Access to data by individual. Upon request to a responsible authority,an individuat shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or conCdential. Upon his further request,an individual who is the subject of storcd privatc or public data on individuals shall be shown the data without any charge to him and,if he desires,shall be informed of the contcnt and meaning of that data. After an individual has bcen shown the private data and informed of its meaning,the data need not be disclosed to him for six months[hercafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected m•created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. Thc responsible authority may require the requcsting person to pay the actual costs of making,certifying,and compiling the copics. The responsiblc authority shall comply immediately,if possible,with any request made pursuant to this subdi��ision,or within five days of the date of the request,ezcluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with thc request within that time,hc shall so inform the individual,and may have an additional five days within which to comply with the reyucst,cxcluding Saturdays,Sundays and legal 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 himselt. To exercise this right,an individual shall notify in writing the responsible authority describing the nature olthe disagreement. The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to noti(y past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he belicves the data to bc correct. Data in dispute shall be disclosed only if the individual's statement o(disagreement is included with the disclosed data. The determination of the responsible authority may be appcalcd pursuant to the provisions of the administrative procedm•e act relaling 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 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 refusal 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 pernut 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. --�v�v� � l�"��i U� First Middle t Address City State Zip Phone I understand my rights as stated above. _:_..__ � `� 7 Sig ature