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Sec.13.04 RIGHTS OFSUBJECTS OFDATA Subdivision 1. Type of data The rrghts ojindividual on whom the data is stored or to be stored shall be as set forth in this sectron. Subd.2. Injo�mation required to be given individuaL An indrvidual asked to supply private or confidential data concerning himself shal!be injormed oj.• (aJ the purpose and intended use of the requested data within the col/ecting state agency,politica!subdivrsion,or statewide system;(b)whether he may refuse or is legally required to supply the requested data,-(c)any known consequence arising from his supplyrng or refusrng to supplyprivate or confidentia!data;and(dJ the identity ofother persons or enlities authorized bystate orfederal law to receive the data. This requirement shall not apply when an indrvidual rs asked to supply investigative data,pursuanl to section 13.82, subdivision S, to a!aw enjorcement o�cer. The commissioner ofrevenue may place the notice required under this subdivision in the indivrdual income tax or property taz re/'und instructions rnstead o(on those forms. Subd.3. Access to data by individuaL Upon request!o a responsible authoriry,an rndividua!shall be informed whether he rs the subject ojstored data on individuals, and whether it is classified as public,private or confidential. Upon his jurther request,an individua[who is the subject of stored prrvate or public data on individuals shal!be shown the data without any charge to hrm and, if he desires,sha[l be informed of the cantent and meanrng ojthat data. After an individual has been shown the private data and informed ojits meaning, the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this sectron is pending or additronal data on the individua!has been collected or created. The responsible authority shall provide copies ojthe private or public data upon request by�he individual subject of the data. The responsible authority may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authorrty shall comply immediately,rfpossible,with any request made pursuant to this subdivision,or within five days of the date ojthe request,excluding Saturdays,Sundays and legal holidays,f immediate compliance is not possible. 1.f'he cannot comply tivith the request within that time,he shal!so inform the individual,and may hme an additional five days ivithin which to comply with the request,excluding Saturdays,Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complet�An rndividual may contest the accuracy or campleteness ofpublic or private data concernrng hrmself. To exercise this right, an individual shall not�in writrng the responsible authority describing the nature of the disagreement. The responsi�le authoriry shallwithin 30 days either: (a)correct the datafound to be inaccurate or incomplete and attempt to nol� past recrpients of inaccurate or incomp/ete data,including recipients named by the individual;or(b)notify the individua!that he believes the data to be correct. Data in dispute shall be drsclosed only 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 provisrons ojthe adminrstrative procedure act relating to contested cases. DATA PRIVACYADVISORY In accordance with M S.13.04,Subd.2,"Rights ofsubjects ofdata",we would like to inform you that your request for a permit or license from!he City ojOrono or any ojits departments may require you to furnish certain private or confidential information. You are notifred that: I. The informatron you furnish will be used to determine your gualification jor[he permit or license requested. 1. You may refuse to supply data,but refusal may require that the Crry deny the permit or lieense. 3. The information may be shared with other local,state or federa!agencies to the extent necessary to process the permit or lrcense. 4. If your requested permif or license requires Council action to approve,some information may become public. 5. You have certain rights under M.S. 13.04(see jo[lowing page)to revieiv private data on yourself. 6. Your full name is required to process lhrs application or permit. PLE SE PRINT -�o h� lc� L. 4,vi dsoc` First Middle Last a�'ao �i4�lC Gfb�s �k. �1/. Address �i4�o�� /�ti. �s.�y�� nsa s��>. �ra� City Sta1e Zip Phone 7' I under�igh�s a stated above. � Signature /0