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Sec.13.04 RIGIiTS OF SUBJECTS OF DATA Subd. 1. Type of data. T'he rights of individual on whom the data is stored or[o be stored shall be as set forth in this secrion. Subd.2. Information required to be given individual. An individual asked to suppty private or confidential data concerning 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 supply the requested data;(c)any lrnown consequence arising from his supplying or refusing to supply private or wnfidential dara;and(d)the identity of o�er persons or entides authorized by srate or federal law ro receive the dara. This requirement shall not apply when an individual is asked to supply invesdgative data, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of revernie mav�lace the notice reauired under this subdivision in the individual income tax or nrocertv tax refund instrucrions 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 classified as public,private or confidenrial. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data wit}►out 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 action pursuant to this section is pending or addidonal data on the individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authoriry shall comp(y 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 tegal 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, ezcluding 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 da�co�erning himself. To exercise this right,an individual shall notify in writing the responsible authoriry describing the nature of the disagreement. The responsible authority shall within 30 days either: (a)wrtect the data found ro be inaccurate or i�omplete and attempt to notify past recipients of inaccurate or ic►complete data,including recipients named by the individual;or(b)notify the individual that he believes the dara to be cottect. 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 pursuant 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�ity 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. Yo.0 may refuse to supply data, but refusal may require that the City deny the permit or license. 3. The information may be shazed with other iocal, 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. Mf�l< I�a-��ur �+� First Middle Last 3�s ��a- L��,s+� a�s� Address Dr�� m� SS3�i I �7� �17�� Ci�y State Zip Phone I understand my rights as stated above. Si re — 6