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� ' Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of i�lividual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Informatton required to be given i�lividual. An individual asked ro supply private or confidential data conceming himself shall be informed of: (a)the purpose and intended use of the roquested data withii►the collecting state agency,political subdivision,or statewide system;(b)whether he may refuse or is legally required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing to supply private or confidential data;and(d)the identiry of ott�r persons or entiaes authorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to sypply investigative data, pursuant to secaon 13.82, subdivision 5,to a law � enforcement officer. The commsssioner of rovernre mav nlace the notice reauired under this subdivision in Uie individual income taz or oronertv taz refund instructions instead of on those forms. Subd.3. Acccgs to data by individual. Upon request to a responsible suthoriry,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 nquest,an individual who is the subject of stored privaoe or public data on individuals shall be shown the daha without any charge W tum and,if he desires,shall be informed of the content aad meaning of that data. After an individual has bcen shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acdon pursuant to this section is pending or addi6onal data on the individual has been collecoed or created. The respoacible authoriry shall provide copies of die private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesting person to pay the acmal costs of making,certifying,and compiling the copies. The responsible authoriry shall comply immediately,if possible,with any request made pursuant w this svbdivision,or within five days of the date of the request,excluding Sauudays,Sundays and legal holidays,if immediate compliance is not possible. If he carmot comply with the request within tbat time,he shall so inform the individual,affi may 6ave an addi6onal five days within which W comply with the request, excluding Saturdays,Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of Fwblic or private data conceming himself. To exercise this right,an individual shall notify in writing the responsffile authociry describing the nature of ihe disagreement. The responsible authority shall within 30 days eid�r: (a)correct the da�found to be imdccarau or incomplete and attempt w�tify past recipients of inaccurnte or incomplete dala,including recipients named by ihe individual;or(b)notify the individual that he believes the data to be correct. Data in dispuu shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the administrative 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�ity of Orono or any of its departments may require you to furnish certain private or confidenrial information. You aze notified that: 1. The information you futnish 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 license. 4. If your requested permit or license requires Council acrion 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. � �. �. � ��f F�S� g l� �S 131��k. V1�►�,�� v- , �t �� �,�.�,,�c, �cr�� '� �'1�t �53�� - -9��aL�v Ci�y State Zip Phone I understand my rights as stated above. � Signawn 6