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y � R \ Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Information required to be given individual. An individual uked to supply private or confiden[ial data concerning himself shali be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,poliacal subdivision, or sta[ewide rystem;(b)whether he may refuse or is legally required to supply the requested data; (c)any lrnown consequence arising from his supplying or refusing cD suppfy privace or confidendal data;and(d)the idenary of other persons or entides authorized by srate or federal law ro receive the data. This requirement shall not apply when an individual is asked to supply investigative data, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav lace the notice re uired under this subdivision in the individual income taz or ro em tax refund instructions instead of on those forms. Subd. 3. Access to data by indiridual. 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 co�denrial. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data without any charge to him and, if he desires,shall be informed of the content and meanin�of that 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 thereafter unless a dispute or action pursuant to this secdon is pending or addidonal data on the individual has been cotlectzd or creared. The responsible authoriry shall provide copies of the privare or public dara upon request by the individual subject of the data. The responsible authority may require the requesrin�person to pay the actual cosu of making,certifyin„and compiling the copies. 'Ihe responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of[he requesc,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that cime, he shall so inform the individual, and may have an addirional five days within which to comply with the request, excluding Sacurdays, 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 privace data conceming himself. To exer�ise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the dara found to be inaccurate or incomple[e and attempt to noafy past recipients of inaccurate or incomplet�dara,including recipienu named by the individual;or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disciosed data. The determinarion of the responsible authoriry may be appealed pursuant to the provisions of the adminisu�adve procedure act relating ro 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 �ity of Orono or any of its departments may require you to furnish certain private or confidential information. You are notified that: , i. 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. First Middle Last Address �L Clry % State Zip Phone I understand my ri ts as tate above. ;� j :. ;�l�/� � �G �� ' Signature • 6 ,