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' � , Sec.13.04 RIGHTS OFSUBJECTS OFDATA ' Subdivision 1. Type oJdata The rights of individua[on whom the data is stored or to be stored shall be as set forth in this section. � Subd.2. Injormation required to be given indivlduaL An individual asked to supply private or confidential data concerning himse f sha/l be injormed of.• (a)the purpose and intended use oJthe requested data withrn the collecting state agency,political subdivision,or statewide system;(b)whether he may refuse or is legally required to supply the requested data;(c)arry known consequence arising from his supplying or refusing to supply private or confrdential datn;and(d)the identity of other persons or enlities authorized by state orfederal law to receive the data. This requirement shall not apply when an individual rs asked to supply rmestigalive data,pursuant to section 13.82, subdivision S,�to a law enforcement o�cer. The commissioner otrevenue mav nlace the notice reauired under this subdivision in 1he individual income tax or nropertv tax refund instructior+s instead of on those forms. Subd.3.Access to data by individur� Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on irrdividuals,and whether it is classifred as public,private or confidential. Upon his further request,an individua!who is the subject of stored private or public data on individuals shall be shawn the data without arry charge to him and,if he desires,shall be rnformed 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 to him for six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authority sha11 provide copies of the private or public data upon request by the ixdivrdunl su6ject of the data. 77re responsible authority may require!he requesting person to pay the actua!costs of making,cert�ing,and compiling the copies. The responsible authority sha/1 comply immediately,:f possible,with arry request made pursuant to this subdivision,or within frv¢days of the date of the reqaest,excluding Saturdays,Sundays and legaJ holidays,rf immediate compliance rs not possible. Ijhe cannot comply with 1he request within that time,he shall so rnform the individual,and may have an additional frve days within which to comp[y with the request,excluding Saturdays,Suxdays and legal holidays. Subd.4. Procedure when data is not accurate or comp�lete An individual may contest the accuracy or completeness ofpublic or private data concerning himself. To exercise this right, an individual shal!not�in writing the responsrble authority describing the nature of the disagreement. The responsible authority shall withrn 30 days either: (a)correct the datafound to be inaccurate or rncomplete and attempt to not� past recipients of inaccurate or incomplete data,including recipients named by the indrvidual,•or(b)not�the individual that he believes the data to be correct. Data in dispute shal/be disclosed only if the rndividual's statement of disagreement is included wrth the disclosed data. The determination of the resporrsible authority may be appealed pursuant to the provisrons of the adminrstrative procedure act relating to contested cases. DATA PRIVACYADVISORY In accordance with M.S.13.04,Subd.2,'Rights of subjects of data';we would like to inform you that yous requestfor a permit or license from the City ojOrono or a�ry of its departments may require you to furnish certain private or confidential information. You are notified thot: /. The information you furnish wr//be used to determrne your qua/ification for the permit or/icense requested. 2. You may refuse to supply data,but refusal may requrre that the Ciry derry the permit or license. 3. The rnformation may be shared wrth other local,state or federa/agencies to the extent necessary to process the permit or license. 4. If yoar requested permit or license requires Council actron to approve,some information may become public. S. You have certain righ[s under M.S. 13.04(see,jollowing page)to review private data on yourself. 6. Your full rwme is required to process this application or permit. PLEASE PRINT First Middle Last Address n � Ciry � State Zip Phone 1 I u st � � ted a Signalure !0