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{ � + Sec.13.04 RICHTS OFSUBJECTS OFDATr1 Su6division 1. Type ojdai¢ The rights of individua!on whom the data rs stored ar to be slored shall be as set,f'orth in this seclicn. t, Subd.2. Injormatian required to be given individuaL An individua!asked to supply private or confrdentia!data concerning himse;� shall be rnformed of.• (a)the purpose and rntended:ese of the requested data within the collecting state agency,political subdivision,or statewide syslem;(b)whether he may refuse or is legally requrred lo supply the requested data;(c)any knotivn consequence arising from his supplyrng or refusing to supplyprivate or confidentral data;and(d)the identity of otherpersons or entities authorized bystale orjederallmv to receive lhe data. This requirement shall not apply when an indivrdual is asked to supply investigative data,pursuant to section 13.82, subdivisron 5, to a Imv enforcement o�cer. The commissioner ofrevenue mav place the notice required under this subdivisron in the individual rncome tax or propertv!ax refund instructions tnstead ojon those forms. Subd.3. Access to data by individunl. Upon reguest to a responsibfe authorrty,an indrvrdua!sha!!be rnformed tivhether he rs the subject of stored data on individuals, and whether it rs classified as public,private or confidentraL Upon hrs further request,an individua!who is the subject of stored privale or public data on individua/s shall be shotivn lhe data tivilhouf arry charge to him and,if he desrres,shall be informed oj � the content and meanrng of that data. AJter an indrvidua!has been shotivn the private data and injormed oJits meaning, [he data need not be drsclosed to hrm for six months thereajter unless a dispule or action pursuant to thrs section is pendrng or additional data on the individual has been collected or created. The responsible authority shall provide copies of the prrvate or publrc data trpon reg:�est by the individual subject of 1he data. The responsible authority may require!he requestrng person to pay the actual costs of making,cert�ing,qnd comprling the copies. The responsible authoriry shal!comply immediately,ifpossible,with any reqi�est made pursuant to this subdivision,or within five days ojthe date oJthe requesf,excluding Saturdays,Sundays and lega!holidays,rf immedrale complrance is not possible. If he canno!comply with the request tivithrn that time,he shall so inform the individt�al,and may have an additional five days tivithin tivhich!o comply�vith the request,excludrng Sahlydays,Sundays and legal holidays. Subd.4. Procedure wl:en data is not accurate or compfete.An individual may contest the accuracy or completeness ofpublic orprivate data concernrng himself. To exercise this right, an indivrdtral shal!not�in writing the responsible authoriry describing the nature of the disagreement. The responsible authorrtyshal!within 30 days either: (a)correct the datajotrnd to be inaccurate or incomplete and attempt to nol� past recrpients ojrnaccurate or incomplete data,including recipients named by the rndividual;or(b)not�the individua!that he believes the data to be correct. Data in dispute shall be disclosed only if�he rndividua!'s statement ojdisagreement is rncluded with the drsclosed data. The determinatron ojthe responsible authoriry may be appealedpursuant to the provisions ofthe administrative procedure ac!relating to contested cases. DATA PRIVACYADYISORY In accardance ivith M S.13.0�1,Subd.2,'Rights ojsubjects ofdara';tive would like to inform you that yourreq:�estfor apermit or license from!he City of Orono or any ojits departments may require you to furnrsh certain private or confrdentia!informatton. You are notifred that. 1. The rnjormation you furnish wi!!be trsed to determrne your qi�alrfrcation for the permrt or license requested. 2. Yoir may refuse to supply data,but refusal may require that the City deny the permit or lrcense. 3. The injormation may be shared ivith other local,state or federal agencies to the extent necessary to process the permit or license. 4. IJ'your requested permit or lrcense requires Council action to approve,some rnjormation may become publrc. 5. You have certain rights under M.S. /3.04(see jolloiving pageJ to revietiv private data on yourselJ. 6. Your jull name is required to process this application ar permit. PLEASE PRINT G�'� �Giw �� First Middle Last 3��/5' �,.�. �� Address � � e�. . - ;�� 3�i� Crry State Zip Phone 1 under nd my rights as s a ed ove. Srgnat 10