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. Sec.13.04 RIGHTS OF S[JBJECTS OF DaTA Subd. 1. Type of data. The righrs of individual on whom che data is stored or to be stored shall be as set forth in this section. Subd.2. Information reqirired to be givea individual. An individuai asked to supply private or confidenrial da[a concerniag himself s6a11 be informed of: (a)the purpose and in[ended use of the requested data within the collecting�tate agency,political subdivision,or statewide sysum; (b)whether he may refuse oY is legaily required co supply rhe requesud data;(c)any lrnown consequence arising from tus supplying or refusing to supply private or confidendal data;and(d)[he idendry of ocher persons or enriaes aurhorized by state or federal law to receive the da[a. This requirement shall not apply when an individual is asked to supply invesrigadve dara,pursuant to section 13.82,subdivision 5, to a law enforcement o�cer. The commissioner of re�enue mav place the nodce required under this subdivision in the individual income tax or Dropertv taz refund instructions inscead of on[hose forms. Subd.3. Access to data by individual. Upon requesc to a responsible 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 further request,an individual who is the subject of stored private or public data on individuals shall be shown rhe data without any charge to him and,-if he desires, shall be informed of the content and meaning of that data. After an individua!has been shown the private data and informed of its meaning,che data need not be disclosed to him for six months thereafter unless a dispute or acdon pursuanc to this secdon is pending or additional data on the individual has been collected or creaced. 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 requesting 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 withut that time,he shail so inform the individual,and may have an addidonal five days within wluch W 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 concerning himself. To exercise this right,an individual shall nodfy in writing che responsible authority describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found w be inaccurate or incomplere and attempt to nodfy past recipienu of inaccurate or incompiete data, including recipients named by che individuat;or(b)noafy the individual tha[he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statemenc of disagreement is included with the disclosed dara. The determinadon of the responsible authority may be appealed pursuant to the provisions of[he administrarive procedure act relating to contested cases. DATA PRNACY 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 Ciry 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 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. g, 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. �� rl��a e.•f � �!'L1� Fi�� Iiddle Last 2a�a--S � /u,( '3� Address �� '.5 5 3 7� ��Z'To� O`�Z� �`�dt3S City State Z�p Phone I understand my rights as stated above. � c Signature