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� � Sea 13.04 RIGHTS OF SIJBdECTS 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. Subd.2. Information req�rired to be given individual. An individual asked to supply private or confidential data concerning himself shall be informed of: (a)the purpose and intended use of the requested data withiit the collecting state agency,polidcal subdivision,or statewide system;(b)whether he may refuse or is legally required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply private or confidential dahd;and(d)the idenary of other persons or entiaes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply.invesugative data,pursuant to section 13.82, subdivision 5, to a law enforcement o�cer. The c�mm�ssioner of revern�e mav nlace the notice reauired under this subdivision in the individual income tax or nronertv tax refund instructions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authoriry,an i�lividual shall be informed whether he is the subject of swred data on individuals,and whether it is classified as public,private or confidential. Upon his further request,an i�ulividual who is the subject of stored private or public data on i�iividuals shall be shown the data without any charge W trim and,if he desires,shall be informed of the contei►["and meaning of that data. After an individual has been shown the private data and informed of iu meaning,the data need not be disclosed ro hiin for six months thereafter unless a dispute or acdon pursuant to this section is pending or additional data on the individual has been collected or creaoed. The responsible authority shall provide copies of die private or public data upon request by the individual svbject of the data. The responsible authority may require the requesting person to pay the actual cosu of making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possible,with any request made pursuant to tivs subdivision,or within five days of the date of the request,ezcluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot compiy with the cequest within that time,he shall so inform the individual,and may have an addirional five days within which to comply with the request, excluding Saturdays,Sundays and legal holidays. S�bd.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 ezercise this right,an individual shall notify in wridng the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)wrrect the data found to be inaccurate or incomplete and attempt to nodfy past recipients of iraccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be cornct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with tt►e disclosed data. The determinaaon 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 inform you that your request for a permit or license from the�ity of Orono or any of its departments may require you to furnish certain private or conf'idential information. • You are 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 extent necessary to process the permit or license. 4. If your requested pemut 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. ��V�C_1/� �1��i� '�l�S�� -- First Middl I.ast .o- '�1n C. � ddress � _ �� J� _'�D�� 1 Ciry State Zip Phone I und tan my rights as stat ove. � ture . 6