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_ � Sec.13.04 RIGHTS OF SL'BJECTS OF DaTA Subd. i. Type of data. The righ�s of individual on whom che data is stored or co be stored shall be as set fonh in this section. Subd.'_. Information required to be given individual. .1n individual asked to supply private or confidendal data conceming himself shall be informed of: (a)the purpose and intended use of the requested data within the collecang'state agency, polidcal subdivision,or statewide system: (b)whether he may refuse or is legally required to supply che requested data;(c)any known consequence arising from his supplying or refusing to supply private or conndendal data;and(d)[he identity of other penons or enndes au[horized by state or federal law to receive[he data. This requirement shall not apply when an individual is asked to supply invesagadve data, pursuant to secaon 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav place the norice reauired under this subdivision in the individual income_tax or propertv tax refund instructions instead of on those forms. Subd. 3. Access to data bv individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals, and whecher it is classified as public, privace or confidenaal. Upon his further request, an individual who is the subject of scored private or public data on individuals shall be shown�he dara wichout any charge to hun and, if he desires, shall be informed of the contenc and meaning of tha[data. After an individual has been shown the private data and informed of iu meaning,the data need not be disclosed to hun for six months thereafter unless a dispute or acaon pursuan[to this section is pending or addidonal data on the individual has been collected or created. The responsible aurhoriry shall provide copies of the private or public data upon request by the individual subjecc of che data. The responsible authoriry may require the requesring person to pay the actual cosu of makine, cerdfying, and compiling[he copies. The responsible authoriry shall comply immediately, if possible, wi[h any request made pursuant to[his subdivision, or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addidonal five days within which to comply wi[h 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 public or private data conceming himself. To exercise this rieht,an individual shall noafy in writing the responsible authority describing the nature of the disagreement. The responsible au[horiry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of inaccurate or incomplete data, including recipients named by the individual;or(b)notify the individual that he believes the data to be correcc. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disctosed data. The de[ermination of the responsible au[horiry may be appealed pursuant to the provisions of the administrarive procedure act reladng to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "RiQhts 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. �'�,�� ,� �`��-1 e� First vtiddle � Last 5� Address �� y� 6,a � � y�y � Ciry State Zip Phone I underst m ri tated ab . Signature