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, � ' � Sea 13.04 RIGHTS OF SLIBJECTS OF DAT� Subd. 1. Type of data. The rights of individual o�whom the data is stored or to be stored shal]be as set forth in this section. Subd.2. Information required to be given indi��dual. An individual asked to supply private or confidential data conceming 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 lmown consequence arising from his supplying or refusing to supply private or confidential data;and(d)the idendry of other persons or enrities authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesaeaave data, pursuant to secaon 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav piace the notice required under this subdivision in the individual income taz or propertv tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. lipon request to a responsib(e authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whether ic is classified as public, private or confidendal. Upon his funher 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 infornted of the content and meaning 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 thereafrer unless a dispute or action pursuan[to this section is pending or addi[ional 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 individual subject of the data. The responsible authoriry may require the requesdng person to pay the actual costs of making, certifying, and compiling the copies. The responsible authority 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 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 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 conceming himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement. The responsible authority shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data, including recipiencs named by the individual; or(b)nodfy the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disaereement is included with the disclosed data. The determination of the responsible authonry may be appealed pursuant to the provisions of the administradve 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 depar[ments may require you to furnish certain private or confidential information. You are notified that: 1. The information you furnish will be used to detemune 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 shazed with other local, state or federal agencies to the extent necessary to process ! I the pemut or license. j 4. If your requested pernut or license requires Council action to approve, some information may become I public. j 5. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. I 6.� ' �our full name is required to process this application or�nit. � �\ � I � P-�� 'C� �--�/' P',�yu� � First��' l�� Vliddle Last , � Addc ss I � � ! � � ' ��, �� C��, /� State Zip Phone i I und r }ny rights �s ated ab ve. I ' ` �� \ \ � � Signamre�` `,�v - \ —