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Sec.13.04 RIGATS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights af individual on whom the data is stored or to be stored shall be as set forth in this secrion. Subd.2. Informatioa required to be given individual. An individual asked ro supply private or confidential data conceming himself shall be informed of: (a)the puipose azd intended use of the requested data within the collecting state agency,poliacal subdivision,or statewide system;(b)whether he may refuse or is legally required to supply the requested data;(c)any Imown consequence arising from his supplying or rofusing to supply private or wnfidential data;and(d)the identiry of other persons or endties authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data, pursuant to section 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of revenue mav�lace the notice required under this subdivision in the individual income taz or uropertv taz refund instrucrions instead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of swred data on i�ividuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who is the subject of stored private 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 dara. 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 thereafter untess a dispute or acaon pursuant to this secdon is pending or addivona(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 uidividual subject of the data. The responsible authority may require the requesting person to pay the actual cosu 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 Saturdays,Sundays and lega!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 additional 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 compieteness of public or private data co�eming Ivmself. To exercise this right,an i�ividual shall noafy in wridng the responsible authority describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data fourd to be inaccurate or i�omplete and attempt to notify past cecipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be cornct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The deterntination of the responsible authority may be appealed pursuant to 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 Gity 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 Ciry deny the permit or license. 3. The information may be shued 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. First Middle Last Address Ciry State Zip Phone I understand my rights as state above. i�� Signawre 6