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.� . ! Sec.13.0-3 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 section. Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himself shall bz informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdi�ision,or statewide system;(b)whzther he may refuse or is legally required to supply the requested data; (c)any known consequence arisine from his supplying or refusin�ro supply private or confidential data;and(d)the identiry of other persons or en6ties authorized by state or federal la« co receicz the data. This requirement shall not apply when an individual is asked to supply investigative data, pursuant to section 13.82, sut�ivision�. to a law enforcement officer. The commissioner of revenue mav�lace the notice reauired under this subdivision in the individual income tax or orocem tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry, an individual shall be informzd whether he is the subject of stored data on individuals,and whether it is classified as public,private or confidential. Upon his furthzr requesc.an individual who is the subjzct 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 disctosed to him for six months thereafter unless a dispute or action pursuant to this section is pending or additional data on the indi�idual has been collectzd or created. The responsible authority shall provide copies of the private or public data upon request by the individual subjzct of the data. The responsible authoriry may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision. or«ithin five days of the date of[he 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 additional five days within which to comply with the request. exc(uding 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 priva[e data concerning himself. To exercise this right,an individual shall notify in writing the responsible authoriry describine the nature of the disaereement. The responsible auihority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attzmp�to notify past recipiencs of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is induded with the disclosed data. The determinadon of the responsible authoriry may be appealed pursuant to the provisions of the adminis[rative procedure act reladne 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 }'our request for a permit or license from the City 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 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. �. You have certain rights under M.S. 13.04 (available upon request) to review private data on vourself. 6. Your full name is required to process this application or permit. ��:�'�� j� ��SN�f_I� First Middle Last � .� `� .� ��I�Cir��, �' Lcr � � ; Address �?�� l:�/J �.� { �� `� �lG'- 7E� / '�'%G� �1 Ciw State Zip Phonz I understand my rights as stated above. ��4. G�/ � �� --�_ Signature 6