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� . Sec.13.04 RIGFITS OF SIJBJECTS OF DATA Subd. 1. Type of data. The righu of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information required to be given individual. An individual asked to svpply private or co�dential data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the col(ecting state agency,polidcal subdivision,or sCatewide 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 confidenaal data; and(d)the identity of other persons or entiaes authorized by srate or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesdgadve data,pursuant to secdon 13.82, subdivision 5,to a law enforcement o�cer. The commissioner of revenue mav nlace the notice cequired under this subdivision in the individual income tax or propertv taz refund insuuctions instead of on those forms. Subd.3. Access to data by mdividual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stoced data on individuals,and whether it is classified as public,private or co�dendal. Upon his further request, an individual who is the subject of stored private or public data on individuals shal!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 meaning, the data need not be disclosed to him for six months the�eafter 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 cesponsible authoriry may require the requesting person to pay the actual costs 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 Sauudays,Sundays and legal holidays,if immediate compliance is not possibie. If he cannot comply with the request within that time,he shall so inform the individual,and may have an additional five days within which to comply with the request,excluding Saturdays,Sundays and legal holidays. Subd.4. Procedure when data is not accvrate or complete. An individual may contest the accuracy or completeness of public or private data co�eming himself. To exercise this right,an individual shali notify in writing the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)wrtect the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,including recipienu named by the individual;or(b)nodfy 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 determination of the responsble authoriry may be appealed pursuant w the provisions of the administrative 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 City of Orono or any of its departments may require you to fumish certain private or confidential information. � You aze 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 shazed with other local,t 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. First Middle Last Address City State Zip Phone I understand my rights as stated above. signature 1�