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� . � �, Sec.13.04 RIGHTS OF S[IB.TECTS OF DATA Subd. 1. Type of data. The righa of individual on whom[he data is stored or to be scored shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal data concerning himself shall be informed of: (a)the purpose and intended use of the requested data within the collecting"state agency,polidcai subdivision,or statewide system; (b)whether he may refuse oY is legaily required to supply the requested data;(c)any laiown consequence arising from his supplying or refusing to suppty private or confidenaal data;and(d)che idendry of o[her persons or endaes au[horized by sta[e or federal law to receive the data. This requirement s6a11 not apply when an individual is asked to supply invesdgadve darn,pursuant to section 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav place the nodce required under this subdivision in the individual income tax or aroaertv tax refund instructions inscead of on those forms. Subd. 3. Access to data by individual. Upon requesc to a responsible authority,an individual shail be informed whether he is the subject of stored data on individuals,and whether it is classified as public,priva[e or confidendal. Upon his furthec request,an individual who is the subject of stored private or public data on individuals shall be shown[he dara without any charge to him and,�if he desires, shall be informed of the content and meaning of[hat data. After an individua!has been shown che private data and informed of iu meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acdon pursuant to this secdon is pending or addidonal data on the individual has been collected or created. The responsible authority shall provide copies of the private or pubiic data upon request by rhe individual subject of che data. The responsible authoriry may require the requesdng person to pay the actual cosrs of making,certifying,and compiling rhe copies. The responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of the tequest,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 addiaonal five days within which to comply with the requesc,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 private data conceming himself. To exercise this right,an individual shall nodfy in writing the responsible authoriry describing the naturo of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and aaempt to notify past recipienu of inaccurate or incomplete data, including recipients named by the individuai;oc(b)nodfy the individual that he believes the data to be correcc. Data in dispute shall be disclosed only if the individual's statemenc of disagreemenc is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the administrarive 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 fumish will be used to detemune 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 is application or permit. �C/C�� Lasc Fi�� , ddle ��/� , /� � r��.r/ �-(�-e Address . �f C�� J� �� '� City State Zip Phone I understand rights as stated above. �� Si ature