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� 1 Sec.13.04 RIGHTS OF SUBJECTS OF D?�TA Subd. 1. Type of data. The righ[s of individual on whom the data is s[ored or[o be stored shall be as set forth in this secrion. Subd.2. Informa[ion required to be given individual. ?.n individual uked to supply private or confidenrial data conceming himself shall be informed of: (a)the purpose and inttnded use of the requested data wi[hin the collecting'state agency, polirical subdivision,or sracewide system; (b)whether he may refuse oi is legally required to supply the requested data:(c)any lrnown consequence arising from his supplying or refusing to supply private or confidenrial data;and(d)[he identiry of other persons or enrities au[horized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesrigadve dara, pursuan�to section 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav lace the notice reauired under this subdivision in the individual income tax or ro ertv tax refund instructions instead of on those forms. Subd. 3. Access to data b�indi��dual. Upon request co a responsible authority,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 confidenrial. Upon his further request, an individual who is the subject of stored priva[e or public dara 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. Afrzr an individual has been shown the private data and informed of its meaning, che data need not be disclosed to hun for six months thereaTter unless a dispute or ac[ion pursuant to this secdon is pending or addirional data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or pubiic data upon request by the individual subject of the data. The responsible authoriry may require [he requesting person to pay the actual cosu of making, cenifying, and compiling the copies. The responsible authoriry shall comply immedia[ely, if possible, with any request made pursuant to this subdivision,or within five days of the date of the request,excluding Sarurdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with[he request within that time,he shall so inform che individual,and may have an addirional 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 pm•ate data conceming himself. To exercise this right,an individual shall noafy in wriang the responsible authoriry describing che nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to noufy past recipients of inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individual thac 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 de[erminadon of the responsible au[horiry may be appealed pursuant to the provisions of the administradve procedure act reladng to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "Riahcs 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 furnish certain private or confidential information. You are notified that: 1. The information you furnish will be used to determine your qualification for the pemut or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the pemut 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. (, Your fuli name is required to process this application or permit. C� � First -�� Midd �� Last � Address ' � � _ ,,,..//� � State Zip Phone City J I understand m rig Signature