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� �s � C ! � 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 secdon. S�bd.2. Information req�rired to be given individual. 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,polirical subdivision,or statewide system; (b) whether he may refuse or is legally required to supply the cequested data;(c)any lmown consequence arising from his supplying or refusing to supply private or wnfidential data;and(d)the iden6ry 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 invesdgative data,pursuant to secaon 13.82,subdivision 5,to a law enforcement officer. The commissioaer of tevemie mav olace the�dce ieauued u�er this subdivision in the iadividual income tax or propertv tax refund insauctions instead of on those forcns. S�bd.3. A�to data by mdividual. Upon request to a responsible authoriry,an individual shall be informed whether 6e is the subject of stored data on individuals,and whether it is classified as�ublic,private or coafidendal. 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. Afrer an individual has been shown the private data and informed of iu meaning,the data need not be disclosed to him for six months theteafter unless a dispute or action pursuant to dus 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 reqnest by the individual subject of the data. 11►e responsible authority may require the requesting person to pay the actual costs of making,certifying,and compiling�e copies. The cesponsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of the request,ezcluding Sawidays,S�ndays a�legal holidays, if immediate compliance is not possible. If he cannot compiy with the request within that tune,he sUall so infocm the individual,and may have an additional five days within which to comply widi the request,excluding Saturdays, Sundays and tegal 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 ezercise dris right,an individual shall norify in writing the nespoasible authority describing the nature of the disagreement. The iesponsble authoriry shall within 30 days either. (a)cornct the data found to be inaccunte or incomplete and attempt to notify past recipients of inaccurate or incomplete da1a,including recipients named by the individual;or(b)noafy the individual that he beGeves the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The detemunation of the responsible authority may be appealed pu�suant 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 departments may require you to furnish certain private or confidential information. You aze 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 eztent 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. �---,-�-m �• ��I�ti� First f�Q Middle�' Last .—{—( . Ad res �/� ^/ 7 V ` � r L Ciry tate Zip Phone I understand my rights as stated above. _.��—. // Signature ' c'� 10