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li Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The righu of individual on whom the data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information req�rired to be givm individual. An individual asked to supply private or confidendal data concerning himsdf shall be informed of: (a)the putpose and inunded use of the roquesud data within the collecting§rate agency.Poliucal subdivision,or staoewide sysoem; (b)whether he may tefuse or is legally nquired to suppty the csqucsted data;(c)aay lmown consequence arising frvm his supplying or cefttsing m supply private or confidenrial data:and(d)che idenary of other pecsons or endaes authorized by state or fedecal law to teceive the data. This requirement shall not app(y when an individual is asked to supply investigadve data,pursuant to secdon 13.82,subdivision 5,m a law enforcement officer. The commissioner of revenue mav alace [he noace reauired under this subdivision in the individual income tax or aroDerev tau refund inswcrions insuad of on those forms. Subd.3. Access to data by indiridual. Upon requesc to a responsible authority,an individual shall be informed whether he is the subject of stored dara on i�ividuals,and whecher it is classified as public, private or co�dendai. Upon his further request,an individual w6o is the subjecc 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 contenc and meaning of[hat data. After aa individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months theteafter unless a d'upute or action pursuant to this section is pending or additionai data on the individuai has been collected or creared. The responsible auchority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible aurhority may require the requesring person to pay the actual cosrs of making.cerdfying,and compiling the copies. The responsibie authority shall comply immediacely,if possible, with any request made pursuant to this subdivision,or within five days of the date of the request,exctuding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within[hat time,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,ezcluding Sanudays, Sundays and legal hotidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or compieteness of pubiic or private data concerning i�imseif. To exercise this right,an individual shall nodfy in writing the responsible authoriry describing the nature of the disagreemenG The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and atumpt w nodfy past recipiencs of inaccurate or incomplete data,including recipienu named by the individuaf;or(b)notify the individuai that he believes the data to be correcc. Data in dispute shall be disclosed onty if the individual's statement of disagreement is included with the disciosed data. The determinadon of the responsible authority may be appealed pursuant to the provisions of the adminisuative procedure act reladng to contested cases. DATA PRNACY 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 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 eztent 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 cenain 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. 'TO V►� F N�e.�+�v �. _ First Middle �L 2 O S O (��'4t.t�cU wr,� Y�t� Address � Lon�� La�ct ►N►►� �3 S G �l,S`-.'lrF�� City State Zip Phone I understand my rights as stated above. � f Signacure