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� Sec.13.04 RIGHTS OF SiJB.TECTS 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 forrh in this section. Subd.2. Information reqtrired to be given individual. An individual asked to supply private or confidendal data concerning himself shall be informed of: (a)the purpose and intended use of the cequesred dara wirhin the collectiag�tatc agency,poliacal subdivision,or stacewide system; (b)whether he may refuse oY is legally required to supply tbe requested data;(c)any Irnown consequence arising€rom his supplying or refusing to supply private or confidendal data;and(d)che idendry of other persons or enddes authorized by state or fedecal law to receive the data. This requirement shall not apply when an individual is asked to supply invesdgadve data,punuant to secdon 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue mav alace the noace re4uired under this subdivision in the individual income tax or propertv tax rofund instrucrions inscead of on those forms. Subd.3. Access to data by individual. Upon requesc to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whecher it is classified as public,private or confidential. Upon his further request,an individuat who is the subject of stored private or�public dara on individuals shall be shown che data without any charge to him and;if he desires,shall be informed of the content and meaning of[hat data. After an individual has been shown the private data and irtformed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acrion pursuant to tlus secdon is pending or addidonai data on the individual has been collected or created. The responsible authority shail 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[he acrual cosu of making,cerdfying,and compiling the copies. The responsible authoriry shall comply immediately,if possible,with anY request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addidonal five days within wluch to comply with ihe 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 concerning himself. To exeicise-this right,an individual shall noafy in wrifing the responsible authority describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to 6e inaccurate or incompiete and attempt to nodfy past recipienu of inaccurate or incomptete data,including recipients named by rhe individual;or(b)notify the individual that he believes the dara to be correct. Data in dispute shaii be disclosed only if the individual's statemenc of disagreement is included with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of ihe administradve 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 pemut or license from the City of Orono or any of its departments may require you to fumish 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 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 permit or license requires Council action to approve, some information may become public. g, 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. �-G.L.� ,S'S'�.h��d� /�..1�'" First Middle Last .�3� 5 N [�--�-1v v Address �(/'/J �'SC��2' �7 j 's3 Z S� n�t d��S City State Ztp Phone I understand rights as stated ovo �'� Si ature