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' � Sec.13.04 RIGHTS OF SIJBJECTS OF DATA , ' } Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this secrion. S�bd.2. Informatton requtred to be�ven individual. An individual asked to supply private or confidendal data concerning himself shall be informed of: (a)the pucpose and intended use of the requested data within the collecting state agency,polidcal subdivision,or stauwide system;(b)whether he may rofuse or is legally required to supply the requested data;(c)any Imown consequence arising from tris supplying or nfusiwg oo supply private or confidential data;and(d)the identiry of other persons or entides authorized by srate or federal law to receive the data. Tfiis requirement shall not apply when an.individual is asked W supply investigadve daha,pursuant to secdon 13.82, subdivision S, to a law enforcement o�cer. The commissio�r of rove�e m3v olace the noticp neauired under�his c��bdivision in the individual income taz or orocertv tax refund instcucdons 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 stored data on individuals,and whether it is classified as public,private or confidendal. Upon his further request,an individual who is the subject of stored private or public data on i�ividuals shall be shown the data without azry 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 thereafrer unless a dispute or action pursuant ro this section is pending or additional data on the i�ividual has been collected or creaoed. The responsble authority shall provide copies of the private or public data upon request by the u►dividual subject of the dara. The responsible suthority may require the roquesting person to pay the actual cosu of maldng,certifying,a�compiling the copies. The responsible authoriry stiall comply immediately,if possible,with azry request made pursuant to this subdivision,or within five days of the dabe of the request,excluding Saturdays,Suexiays 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 additional five days within which to comply with the request, exctuding 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�conceming himself. To eze�ise this right,an individual shall nqdfy in writing the responsible authoriry describing the nature of the disagreement The responsible audwriry shall within 30 days eittur: (a)correct the data found oo be inaccurate or i�omplete a�attempt to notify past recipients of inaccuraoe or incomplete data,including recipients named by the i�ividual;or(b)eyodfy 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 respoasible authoriry may be appealed pursuant to the provisions of the administrative procedure act relating to contested cases. DATA PRiVACY Ai�VISORY 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 Giry 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 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 lic�nse. - 4. If your requeste�i permit or license requires Council action to approve, some information may become � public. S. 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. T/-�o,�,,Q� ��.�r �s T�� y gi�� Middle Last 3yo �� .¢.�' �` Add/ress / /�V'7i �S �/�'I�C t.' /VrO�. J� .3� �7(v "',�r`�.�� Ciry State Zip Phone I understand my rights as stated a .`\ � Signawre 6