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� Sec.13.04 RIGHTSOFSUBJECTSOFDATA Subdivision 1. Type ojdata The rights of individua!on whom the dqta is stored or to be stored shal!be as set forth in this section. Subd.2. Injormatlon required to be givex individuaL An rndivrdual asked to supply private or conf dential data concerning himsetf shall be infornred of (aJ the purpose and intended use of the requested data within the co!/ecting state agency,polrtica!subdivrsron,or statewide 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 confidenlia[data;and(d)the identity of other persons or entities authorized by state orfederal law to receive the data. Thrs requirement shall not apply ivhen an indrvidual rs asked to supply irrvestigative data,pursuant to section/3.82, subdivision 5, to a law enforcement o�cer. The commrssioner of revenue mav place the notice reouired undes this subdivision in the indivrdual income tax or nroDerty tax refund instructions instead of on those lorms. Subd.3. Access to data by individuaL Upon�equest to a responsible au[hority,an individual shall be informed whether he is the subject o,f'stored dala on indivrduals,and whether it is classrfied as public,prrvate or confrdential. Upon hrs fur�her reques�,an individual who is lhe subject of stored private or publrc data on individuals shall be shown!he data wrthout arry charge to him and,if he desires,sha!!be injormed of the content and meaning of that data. AJler an rndividual has been shoivn the private data and rnjormed ojits meaning, the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this section rs pendrng or additiona!data on the individua!has been collected or created. The responsible authority shall provide copres of the private or public dala upon request by the rndrvidual subject oj the data. The resporrsible authority may require the requestrng person to pay the actual costs of making,cert�ing,and comprling the copies. The responsrble authority sha!/comply immediately,ifpossible,with any request made pursuant to this subdivision,or tivilhrn frve days oJthe date of the request,excluding Saturdays,Sundays and legal holidays,if immedrate compliance is not possible. I,f he cannot comply ivith the request within that time,he sha!!so injorm the indivrdual,and may have an additionalfrve days wrthin whrch to comply ivith the request,excluding Saturdays,Sundays and legal holidays. Subd.4. Procedure when data is rtot accurate or complete.An individua!may contest the accuracy or comple�eness ofpublic or private data concerning himse f To exercise thrs rrght, an individual shall notify in writing the resporuib[e authoriry describing the nature of the disagreement. The resporuible authorrty shall wilhin 30 days either: (a)correct the datafound to be inaccurate or incomplete and attempt to not� past recipienfs of inaccurate or incomp[ete data,including recipients named by the indrvidual;or(bJ not�the indrvidual that he believes the data to be correct. Data in dispute shal/be disclosed only rf the indrvidual's slatement of disagreement is rncluded with the disclosed data. The dete�mrnation of the responsible authority may be appealed pursuant to the provisions ojlhe admrnistrative prxedure act relating to contested cases. DATA PR![�ACYADVISORY In accordance with M.S.13.04,Subd.2,'Rights ofsubjects oJdata';we would lrke to inform you lhatyour request for a permit or license jrom the City of Orono or any of its departments may require you to furnish certain private or confidential rnformation. You are notrfred that: 1. The information you furnish wr[1 be used to determine your qualrfrcation for the permi!or lrcense requested. 2. You may rejuse to supply data,but refusal may requrre that the City deny the permit or license. � 3. The informatron may be shared with other local,stale or federa!agencies[o the extent necessary to process the permit or Ircense. 4. !f your requested permit or license requires Council action to approve,some injormation may become public. 5. You have certain rights under M.S. l3.04(see fo!lotiving page)to review private dala on yourself. 6. Your full name is required to process this applicatron or permit. PLEASE PRINT �� NARtl �i�f��7'� Frrst Middle L,ast 34 7 Z L,1i/�t rVG�sTaw Av�� Address /�Ay'a�A /1'Iw S�3 9/ �/-oa/o Ciry State Zip Phone I understand my ri rts n stared above. Si tatu�e 10 4