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y. M � Sec.13.04 RIGHTS 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 secdon. Subd.2. Information required to be givea indiridual. An individual azked to supply private or confidential data conceming himself shall be informed of: (a)the piupose and inte�ed use of the requested data within the collecting state agency,political subdivision,or statewide rystem;(b)whether he may refuse or is legally required to suppty the requested dara;(c)any lmown consequence arising from his supplying or refusing to supply private or confidential daa;ac�(d)the identiry of other persons or entides authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data,pursuant to secaon 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav olace the notice rcauired under this�+ibdivici n in the individual income raz or oro rtr tax refund in��ceons mstead of on those forms. Subd.3. Access to data by individual. Upon request W a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is ctass�ed as pub6c,private or co�dendat. 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 W him and,if he desires,shall be informed of the content and meanin�of that data. Aher an individual has been shown the private data and informed of iu meaniag,the data need aot be disclosed w him for six months thereafter unless a dispute or acaon pursuant to this secaon is pending or additional data on the individual has been collected or creared. The respor�ible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsibie au[horiry may require the requesdng person to pay the actual cosu of making,certifying,and compiling the copies. The responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or wi[hin five days of the date of the reques[,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with [he request within that ame,he shall so inform the individual,and may have an addidonal 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 himself. To exer�cise this right,an individual shall notify in wriring the responsible authoriry describing the�ature of the disagreement The responsible authoriry shall within 30 days either: (a)correct the data found to be umccurace or incomplete and attempt w nodfy past recipients of inaccurare or incomplete data,including recipients named by the individual;or(b)noafy the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individuai'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 adminis�ative procedure act relating [o contesmd cases. DATA PRIVACY ADVI ORY 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 �iry 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 Ciry 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 pernut 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. First ( �C� � n � �� iddle v� Last a.[. Address � c � cv�a � 9'Sz ?�-�29'f` Ciry State Zip Phone derstan tate . SignaNr 6