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Y r Sec.13.04 RIGEiTS 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 conceming hirsiself shall be informod of: (a)the pu�pose 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)the identiry of other persons or entities authoriud by sta[e or federat law to receive the data.This requirement shall not apply when an individual is asked to supply investigative data,pursuant to section]3.82,subdivision 5,W a law enforcement officer. The commissioner of revenue rnav nlace the notice required under this subdivision in the individual income tax or p,roDercv tax refund ins[ructions instoad 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 whether it is classified as public,private or confidential. 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 its meaning,the data need not be disclosed Co him for six months thereafrerunless a dispute or action pursuant to this scction 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 individual subjec[of the data. The responsible authority may require the requesting person to pay the acNal costs of making,ceRifying,and compiling the copies. The responsible authority shall comply immediately,if possible,with any request made pursuant to[his 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 himsel£To exercise this right,an individual shall no[ify in writing the responsible a¢thority describing the nature of the disagreement.The responsible suthoriry 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 recipients named by the individual;or(b)notify the individual tfiat he believes the data to be correct.Data in dispute shall be disclosed onfy if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the administrative 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 infoim you that your request for a permit or license from the City of Orono or any of its depariments 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 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 yoursel£ 6. Your full name is required to process this application or permit. First Middle Last Jo� � �� lao,� - Address � L-e.l%r„�n.�� r�i,� ��0��1 7/3`7�33-71�J City State Zip Phone I understand my rights as stated above. Signature 32