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. � _- `� Sea 13.04 RIGHTS OF SiJBdECTS OF DATA Subd. 1. Type of data. The righu of individual on whom the data is stored or to be stoced shall be as set forth in this secdon. Subd.2. Information required to be given individual. An individual asked to supply private or confidendal data conceraing himself shall be infotmed of: (a)the purpose and inunded use of the requested data within the collecting'state agency,polidcal subdivision,or statewide system; (b)whether he may refuse or is legally required to supply the requested data;(c)any Imown consequence arising from his supplying or refusing to supply private or confidential data;and(d)the idenriry of other penons or endties authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesugative data, pursuant to secdon 13.82, subdivision 5,to a law enforcement officer. The commissioner of revenue mav alace the nodce required under this subdivision in the individual income tax or proDerty taz refund instnicrions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whethec it is classified 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 dara without any charge to him and, if he desires, shall be informed of the content and meaning of that data. Afrez an individual has been shown the private dan and informed of its meaning, the data need not be disclosed to him for siz months thereaher unless a dispute or acuon pursuant to dvs secdon is pending or additional dan on the individual has been coilected 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 penon to pay the actual cosu of making,certifying,and compiling the copies. The responsible authority shall comp(y 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 legat holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shail so inform the individual,and may have an addidona!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 oc compieteness of public or private data concerning himself. To exercise this right,an individual shall nodfy in writing the rosponsible 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 atiempt to notify past recipien[s of inaccurate or incomplete data, including recipienu named by the individual;or(b)notify the individuai that he believes the data to be correct. Data in dispute shall be disciosed only if the individual's statement of disagreement is inctuded with the disclosed data. The deterrnination of the responsible authority may be appealed pursuant to the provisions of the adminisaadve 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 furnish certain private or confidential information. You are notified that: 1. The information you fumish 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 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. �r�v �t �l�/�Farr�- �U�f.s aiv �/�� First ddle Last 100 � �t� s� �ow�1 Address c �� C 3 � 6 . Ci� State Zip Phone I understand my rights as stated above. �/1/l/f.�.Q� /��—�� c� f , s�g��n