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, � 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 asked to supply private or confidential data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b) whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidential data;and(d)thc identity of other persons or entities authorized by state or federal law to receive the data.This requirement shall not apply when an individual is asked to supply investtgative data,pursuant to section 13.82,subdivision 5,to a law entorcement officer. The rnmmissioner of revenue mav olace the notice reauired under this subdivision in the individual income tax or orooertv tax refund lnstructions instead of on those forms. Subd.3. Access to data by individuai. 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 confidential. Uport 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 intormed of the content and mea�ing of that data. Atter an individual has been shown the private data und informed of its meaning,the data need�ot be disclosed to h[m for six months thereafter unless a dfspute or action pursusnt to this section is pending or additional data on the individual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by the I�divldual subject of the data. The responsible suthorlty may require the requesting person to pay the actual costs oi making,certifying,and compiling the copies. The responsible authority shall rnmply immediately,if possible,with a�y request made pursuant to this subdivision,or within five days of the dste 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 additional�ve days within which to comply with the request,excluding Saturdays,Sundays and legul holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness oCpublic or private data concerning himself. To exercise this right,an individual shall notlfy In wrlting the responsible authority describing the nature of the disagreement.The responsibie authority shall within 30 days either: (a)correct the datu found to be inaccurate or incomplete and attempt to notify past recipients ot inaccurate or Incomplete datu,including recipients aamed by the individual;or(b)notify the indlv(duai that he believes the data to be correct. Data in dispute shall be disclosed only If the individual's s[atement of disagreement is included with the disclosed datu. The determination of the respoasible authority may be appealed pursuant to the provisions ot the administrative procedure act relating to contested cases. DATA PRIVACIr 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 locat,state or federal agencies to the extent necessary to process the permit 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. 6. Your full name is required to process this application or permit. First Middle Last Address City State Zip Phone I understand my rights as stated abov v'-'�� Signature