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► �r 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 Uus section. Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concernin�himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or5tatewide system;(b)whether he may refuse or is legally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supplY private or confidential data;and(d)the idendry of other persons or en6ties authorized by state or federal law to receive the data. T6is requirement shall not apply when an individual is asked to supply investigative data, pursuant to section 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav olace the notice reauired under this subdivision in the individual income tax or nrocertv qx refund instructions instead of on those forms. `S�Ybdt 37 Atcess to data by individu�.�Upon iequest to a responsible autho'riE}f,an irid'ividaal shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or co�dential. 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 to him and,if he desires,shall be informed 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 ,c�isclosed to hiT��r six months thereafter unless a dispute or actionpqrsuant,to this sectipn is pe�iuigsor;a,�diqunal data on the individual has been collec�te.d or created. The responsible authoriry 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 cosu of making,certifying,and compiling the copies. The responsible authoriry shall comply immediately,if possible,with any request 4nade pursuant to tlus subdivision,or within five days ? of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate'�ompliance is"not possible. If he cannot comply with the request witivn that time,he shall so inform the individual,and may have an addirional five days within which to comply with the request, excluding Saturdays,Su�ays and legal holidays. - 3ubd.4. Proc�da,re when data is not accurate or complete, an indivi�ual.ma�contest the ae.curaqy or completeness of public or private data conceming himself: To exe�cise this right,an individual shall notify in wridng.the responsible authoriry describing the nature of the disagc�ement. 'fhe responsible�authority shali within 30 days either: (a)co�rect the data fouhd to be`in�ccurate or i�omplete and attempt to notify pastrecipidnts of inaccurate or,pqco�►plete dara>ic�luding recipients.,�►amFd by�h�individua�;or(b)nqtify 4he individual that he believes the data to be eorrect. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authoriry may be appealed pursaant to ttie provisions of fhe 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 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 tnay refuse to supply data, but refusal may,require that the City deny the permit or license. .,. :. �� The information may�tie s'hazed with oYhe�loc�t, 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. �Aew�l� ' � ; 1l�U�FI �►tr.Irtiic�a��ilrt. - First Middle Last �s� '1H�R.�a f e►�•a� �.�.•�D Address IYLcttJ►t•.1 p Mt�+ S'Y?�♦ �lC'i--�'11' 11'L�+ Ciry State Zip Phone I understand my rights as stated above. . , , . . > , .. � D��Q Signature 6