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r � Sea13.04 RIGHTS OF SUB.TECTS OF DATA Subd. 1. Type of data. The righcs of individual on whom the data is stored or to be stored shall be as set forth in this secaon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidential dara conceming himself shall be informed of: (a)the purpose and inrended use of the requested data within the collecting'state agency,polidcal subdivision,or sratewide system; (b)whether he may refuse or is legally required to supply the requested data;(c)any Irnown consequence arising from his supplying or refusing to supply private or confidendal data;and(d)the idenriry of o[her persoas or enriaes authorized by state or federai!aw to receive the data. This requirement shall not apply when an individual is asked to supply invesrigaave data, pursuant to section 13.82, subdivision 5, to a law enforcement ofFicer. The commissioner of re�enue mav place the nodce reauirEd under this subdivision in the individual income tax or propertv tax refund instruccions inscead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals, and whether it is ciassified as public, private or confidendal. 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 meaning of that data. After an individual has been shown the private data and informed of iu meaning, the data need not be disclosed to him for six months thereafter unless a dispute or acdon pursuant to this section is pending or addiUonal data on the individuai 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 data. The responsible authoriry may require the requesting person to pay the acrual costs of making, certifying, 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 Sarurdays,Sundays and legal holidays,if immediace 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 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 comp(eteness of public or private data concerning himself. To exercise this right,an individual shall nodfy in wridng the responsible authoriry describing rhe nacure of the disagreement. The responsible authoriry shatl 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 recipienrs named by the individual; or(b)noafy the individual that he believes the data to be correct. Data in dispuce shall be disclosed only if the individual's statemen[of disagreement is included with the disclosed data. Tlie determinarion of the responsible authoriry may be appealed pursuant to the provisions of the adminiscradve procedure act relating 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 fumish certain private or confidential information. You are notified that: 1. The information you furnish will be used to detemune your qualification for the pemut 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 permit 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. (, Your full name is required to process this applica�n or permit. �/�J l�fi��' `� S `Y`'��-�--� First Middle Last S�i"1 S L-`1 VV LL�� L�� Addre � � � �� b � C� � � `__4�� _.C�� �`i�"�v 1�;C� G`� Ciry State Zip Phone. I understand my ri�hts as stated�ov@ �'" �...,-' Signature