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.. ,`-- . * 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 tkus section. Subd.2. Information required to be given individual. An individual asked to supply private or confidential data conceming himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting state agency,political subdivision,or statewide system;(b)whether he may refuse or is legally required to svpply the requested data;(c)any laiown consequence arising from his supplying or refusing to supply private or coafidential data;and(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 section 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav olace the no6ce rewired under this subdivision in the individual income taz or nrocem taz refund instnicaons instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is class�ed as public,private or confidential. Upon lvs further request,an individual who is the subject of stored private or pubiic 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 meaniag,the data need not be disclosed to him for six months thereafter unless a dispute or acrion pursuant to dus secaon is pending or addidonal data on the 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 authority may require the requesEing person to pay the actual cosu of making,certifying,and compiling the copies. The responsible authority 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 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 concerning lumself. To exercise this right,an individual shall nodfy in writing the responsible authoriry describing the nature of the disagreement. The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or i�omplete a�i attempt to notify past recipients of inaccurate or incomplete daha,including recipients named by the individual;or(b)norify the individual that he believes the data to be conect. 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 authority may be appealed pursuant to the provisions of the 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 pertnit or license from the�ity of Orono or any of its departments may require you to fumish certain private or confidential information. You are notified that: i. 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. 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. - �1,��u L ��,� First Middle Last Address Ciry State Zip Phone I understand my rights as stated above. Signature - 6