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Sec.13.04 RIGHTS OF SUB.TECTS OF DAT?i Subd. 1. Type of data. The righu of individual on whom rhe data is stored or to be stored shall be as set forth in this secrion. Subd.2. Information required to be givess individual. An individual asked to supply private or confidenaal data concerning himself shalf be infocmed of: (a) the purpose and intended use of che requesced data wichin the collecnng stare agency, polidcal suodivision, or sratewide sysrem; (b) wherher he may refuse or is legally required co supply the requested data; (c)any known consequence arising from his supplying or refusing co supply private or confidenaal data; and(d)the idendty of othez persons or entities authorized by sta[e or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigaave data, pursuant to secrion 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav place the noace�equired under tfus subdivision in the individual income rax or propertv tax refund instructions instead of on those farms. Subd.3. Access to data by individual. Upon request to a responsibie authoriry, an individual shall be informed whether he is the subject of sto�ed 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 pubiic 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 data. After an individual has been shown the private data and informed of its meaning, the data need not be disctosed to him for siz mon[hs thereafrer unless a dis�ute or acrion pursuant to this secrion is pending or addiaonal data on the individual has been collected or crea[ed. The responsible au[hority shall provide copies of the private or public data upon request by [he individual subject of the data. The responsible authoriry may require the requesting person to pay the actual cosu of making, certifying, and compiling the copies. The cEsponsible authority shall comply immediately, if possible, with any request made pursuant to this subdivision, or wi[hin five days of th� dare of the c�quest,excluding Sanirdays,Sundays and legal holidays, if immediace compliance is not possible. If he cannot comply with the request wi[hin rhat ume,he shall so inform the individual,and may have an addirional five days within which to comply with the request, excluding Sa[urdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. F,n individual may contest the accuracy or completeness of public or private data conceming himself. To exercise this right, an individual shall notify in wridng the responsiole authority describing the nature of the disagreemen[. The responsible authority shall widiln 30 days either: (a)cottect the data found to be inaccurate or incomplete and attempt to notify past recipienu of inaccurate or incomplece data, including recipienrs named by the individual;or(b) notify [he individua( �ha[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 disctosed data. The determinadon of the responsible authoriry may be appealed pu�uant to the pmvisions of the administradve procedure act reladng to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of da[a", we would like to inform you that your request for a pemut 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 fumish will be used to determine your qualification for the pemut 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 this application or pemut. �r�C.. Wa�ru' v� LD ✓� Firstrj�� Middle t � �� IN 4'l,• 94•�S'S Addr f�' �'• �a �u SSllo �� S� • 45�-65`�(� Ciry State Zip Phane I under and my righ as stated above. � Signature 1�