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Sec.13.04 RIGHTS OF S[TB.TECTS OF DATA Subd. 1. Type of data. The righ�s of individual on whom[he data is stored or to be stored shall be as set forth in this section. Subd.2. Information reqtrired to be given individual. An individual asked to supply private or confidenaal data concerning himself shall be informed of: (a)the purpose and intEnded use of the requested data within the collecting'state agency,polidcal subdivisioo,or sratewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any lmown coasequence arising from his supplying or refusing to supply priva[e or confidenriai data;and(d)the identiry of other persons or ennaes au[horized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investieaave dara, pursuant to seccion 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of revenue mav pla�e the noace reauired under this subdivision in the individual income tax or oropertv tax refund instruc[ions instead of on those forms. Subd. 3. Access to data by indi��dual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public, private or confidendal. Upon lus further request,an individual who is the subject of stored private or public data on individuals shall be shown the dara wi�hout any charge to hun and, if he desires, shall be informed of the content and meaning of that data. A�tzr an individual has been shown the private data and informed of its meaning, the data need not be disclosed to him for six mon�hs thereafter unless a dispute or acrion pursuant to this secdon is pending or addidonal data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the daca. The responsible authoriry may require the requesting person to pay the actual costs of making, cerrifying,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►egal holidays,if immediate comp(iance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addiaonal five days within which to 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 public or private data concerning himself. To exercise this rieht,an individual shall nodfy in writing the responsible au[horiry describing�he�ature of the disagreement. The responsibte authoriry shall within 30 days either. (a)correct the data found ro be inaccunte or incomplete and attempt to nodfy past recipients of inaccurate or incomplete data, including recipiencs named by the individual; or(b)nodfy [he individual that he believes the data to be cocrect. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. Tlie de[erminarion of the responsible authoriry may be appealed pursuant ro the provisions of the administrarive procedure act rela[ing 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 pernut or license. 4. If your requested pernut 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. (. Your full name is required to process this appiication or permit. � �n�'7/'�z�� '(/rz i� Firsc � M�ddle Lasc �� '7t�/�/�6 V � ,(�2,�'� Address C�d�;;�p l�Lt� 5s�3 s(P 9„�-y"y�—c�y�/�7 City State Zip Phone I understand my ri?hts as stated above. ��_ � Signa re