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, i � Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type o[data. 'Ibe rights of individual oa whom the data is stored or to be stored shall be as set forth in dus section. Subd.2. Informatioa req�ed to be gfven individual. An individual asked w supply private or confidential data concerning himself shall be informed of: (a)du pucpose and ime�ed use of the requesud 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 lawwn consequeace arising from his suPPtY�B or refusing ro�pply private or confidential data;and(d)the ideruiry of other persoat or ernities authorized by siate or federal►aw to receive the dara. This requirement shall not apply w6en an individual is asked to svpply investigative data, pursuant to section 13.82, subdivision 5,to a law enforcement officer. The cort�m�ssioner of revenue mav olace dte notice rewired under this subdivision in the individual income tax or nrooertv tax nfiu�d inctttcaons instsad of on choss forms. Subd.3. Access to data by individual. Upon nquest to a responsible authoriry,an individual st�all be informed whether he is the subject of sWrod data on ic�ividuals,and whether it is classified as public,private or confidenaal. Upon his further request,an individual who is the subject of stored privare or public 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 tias been shown the private data and informed of its meaning,the darn need not be disclosed to him for siz months thereafrer unless a dispute or action�rsuant to this section is pending or addidonal data on the individual has been collected or created. The responsible authoriry shall provide wpies 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 authoriry shall comply itnmediately,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 addiuonal five days within which to comply with the request, excluding Saturdays,Sundays and tegal 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 this right,an individual shall notify in writing the responsible authority describing the nature of the disagreeme�u. The responsible authoriry shall within 30 days either: (a)correct the data found ro be inaccutate or i�omplete and attempt to notify past rxipients of inaccurau or incomplete data,i�luding recipienu named by the individual;or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The detemvnadon of the responsible audwrity may be appealed pursuant to the provisions of the administrafive procedure act nlating 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. 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. l � � � ,.,Y/' , �• � (1.fcSlt'�" /har+�as Prsc,�,�/ r_�S -- First � Middle Lasc 7� L/ /'/K�S'�r'llt� C�;� Addre , . , a .za-� /1/. �'3 / /-o�'Sq Ciry State Zip Phone I understand my rights as stated above. Signawre ` _ . , �.. . . , � � . ':� � 6