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� _ * Sec.13.04 RIGHTS OF S[JBJECTS 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 reqirired 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 requesced dara within ttie collecting§tate agency,political subdivision,or statewide system; (b)whether he may refuse oY is legally required co supply the cequesud data;(c)any known consequence arising from his supplying or refitsing w supply privace or confidential data;and(d)the identiry of o[her persans or enuaes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesrigadve dara,pursuanc to secdon 13.82,subdivision 5,to a law enforcement officer. The commissioner of revenue mav place the nodce required under this subdivision in the individual income rax or_DroDertv taz refund instcuctions inscead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whe[her it is classified as public,private or confidential. Upon his further requesG��dual who is the subject of stored private or public data on individuals shall be shown the data wirhout 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 iu meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acdon pursuant to this secaon is pending or addidonal data on t6e individual has been collected or created. The responsible authority 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 authority shall comply immedia[ely,if possible,with any request made pursuant to this subdivision,or within five days of the date of die request,excluding Saturdays,Sundays and legal holidays,if immediau compliance is not possible. If he cannot comply with the request within that dme,he shall so inform the individuai,and may have an additional five days within which to comply with the request,excluding Satucdays, 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 exercise[his right,an individual shall nodfy in writing the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found ro be inaccurate or incomplete and attempt to nodfy past recipients of inaccurate or incomplete data,including rocipients named by the individual;or(b)noafy the individual that he believes the data to be correcc. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determinadon of the responsible authoriry may be appealed pursuanc to the provisions of the administraave 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 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 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 permit 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. 5her � �nr� 1'c��'�'� First Middle Last .3U 05 �11)1 rl�.��'O!� 1�U � Address y�/� [� ,J • � -t'G I � �� -1� '"7�� n��n _ City State Ztp Phone I understand my rights as stated above. Signature