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, . i Sec.13.04 RIGH'TS OF SUB.TECTS OF DAT� Subd. 1. Type of data. The ri¢hts of individual on whom the data is stored or to be stored shall be as set forth in this secrion. Subd.2. Information reqtared to be given individual. .�n individual asked to supply private or confidenrial data concecning himself shali be informed of: (a)the purpose and intended use of the requested data within the collecang'stace agency,poliacal subdivision,or sratewide system; (b)whether he may refuse or is legally required to supply the requested data;(c)any Irnown consequence arising from his supplying or refusing to supply private or confidencial data;and(d)the idenriry of ocher persons or enndes authorized by state or federal law to receive che data. This requiremenc shall not apply when an individual is asked to supply invesaeaave data, pursuant to secaon 13.82, subdivision 5, to a law enforcement officer. The commissioner of re�enue mav place the noace reauired under this subdivision in the individual u:come tax or propem tax refund instructions ins2ad of on those forms. Subd. 3. Access to data by individual. Upon reques[to a responsible au[horiry,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public, private or confidential. Upon his further request, an individual who is the subject of scored private or public data on individuals shall be shown the data wirhout any charge to him and, if he desires, shall be informed of[he contenc and meaning of that data. Ahzr an individual has been shown the private data and informed of its meaning,the daci azed not be disclosed to hirn for six months thereafter unless a dispute or acaon pursuant to this secdon is oending 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 rhe dara. The responsible authoriry may require the requesting person to pay the acrual costs of makine,cerafying, and compiling the copies. The responsible authoriry shall comply immediately, if possible, wi[h any request made pursuant to[his subdivision,or within five days of the date of the request,exciuding 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 addidonal five days within which to comply wi[h the request,excluding Samrdays, 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 pricate data conceming himself. To exercise rhis right,an individual shall nonfy in wri[ing the responsible authori[y describing rhe nature of the disagreement. The responsibte authoriry shall within 30 days either: (a)correct the data found to be inaccunte or incomp(ete and a[z.:mpt to norify past recipienu of inaccurate or incomplete data, including recipients named by the individual; or(b)notify the individual that he believes rhe data to be correct. Data in dispute shall be disclosed only if the individual's sta[ement of disagreement is included wi[h the disclosed data. The de[ermination of the responsible authoriry may be appealed pursuant to the provisions of the admuustrarive 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 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 o[her local, state or federal a�encies to the e�tent necessary to process the pernut or license. 4. If your requested pernut or license requires Council action to approve, some information may become pubiic. 5, You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. (. Your full name is required to process this application or permit. First Middle Last Address Ciry State Zip Phone I understand my rights as stated above. , ,� �> � �,�,%' �,3ignanyre' / � t