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_ . � Sec.13.04 RIGHTS OF SLlB.TECTS OF DATA Subd. 1. Type of data. The righ[s of individual on whom the data is stored or co be stored shall be as set forth in this secdon. Subd.2. Information reqirired to be given individual. ?.n 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"stace agency, polidcal subdivisioo,or statewide system; (b)whether he may refiise o'r is legally required to supply[he requested data;(c)any Irnown consequence arising fmm his supplying or refusing to supply • private or confidendal data;and(d)the idenriry of ocher persoas or enrides authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesrieaave dara, pursuant to secdon 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav place the nodce reauired under this subdivision in the individual income tax or propem tax refund instructions 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 whe[her 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 individuals shall be shown the data wichout any charge to him and, if he desires, shall be informed of the contenc and meaning of that data. Afrer an individual has been shown[he private data and informed of iu meaning, the data need not be disciosed to hun for six months[hereafter unless a dispute or acdon pursuant to this secrion is pending or addidonal data on the individual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the actual coses of making, certifying, and compiling the copies. The responsible authoriry shall comply immediate(y, if possible, with any request made pursuant to this subdivision, or within five days of the date of[he request,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 request,exciuding 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 concerning himself. To exercise[his right,an individual shall notify in wridng the responsible authori[y describing the nature of the disagreement. The responsibte authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplece and attempt to nodfy past recipienu of inaccurate or incomplete data, including recipients named by the individuai; or(b)notify the individual that he believes rhe 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 detecminacion of the responsible authoriry may be appealed pursuant to the provisions of the administndve procedure act reladng 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 deternune 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 pemut or license. 4. If your requested pernut 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 permit. ;�i/��c ��. Jc�� .. �-_ � Firsc �'� ,_,',._.___ `t ti:� �;� Jl`_f�`.��2. Address Ciry State Zip Phone I understan my righ[s tated�ve. /` . -��-� �� ; � 1 � -� , , Signamre �'