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'� ,.;, Sec.13.04 RIGHTS OF SUBJECTS OF DaTA Subd.i. Type of data. The rights of indi�idual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Information required to be given individaal. An indi�idual asked to supply private or confidential data concernine himcelf shall be informed o[: (a)the purpose and intended use o[t6e requested data within the collecting state agencc,political subdivision,or statewide system;(b) whether he may refuse or is legally required ro supph the requested data;(c)a�y known consequencn irising from his supplying or reCusing to supply private or confidential data;and(d)the identity of other persons or entities authorized by state or federii taw to receive the data. This requirement shall not apply when an individual is asked to supply in�esti;ati�e data,pursuant to section 13.82,subdicision 5,to a law enforcement officer. The commissioner of revenue mav lace the noh'ee re uired under this subdivision in the individual income tax or ro ertv tax refund instructions instead of on those forms. Subd.3. Access to data by indicidual. tipon request to a respoosible authority,an individu�l shal!be informed whet6er he is the subject of stored data on individuais,and whether it is classified as public,private or confidentiaJ, lipon his furt�er request,an individua!w ho it the subject of stored private or pubiic data on individuals shall be shown the data without any cha se to him and,if he desires,shail be informed of the content and meaning o[that data. After an individual has been shown the private data and informed of its meani�-the data need not be disclosed to him for six months therea[ter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authority shall provide copies of the private or public data upoo request b}�the individua!snbject of the data. The responsibie authority may require the requesting person to pay the actual costs of maldne,certifying,and compilins the copies. The responsible authority shall compiy immediatef}�,if passibie,w ith any request made pursaint to this subdivision,or w ithin five days of the date of the request,excluding Saturdays,Sundays and le;al hofidays,if immediate compliance is not poss�le. If he cannot compl}�with the request within that time,he shall so inform the individual,and may hace an additional five days within which to comph-.�ith the request,excludina Saturdays,Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An iodividual may contest the acaaracy or completeness of public orprivate data concerning himself. To esercise this right,an individuaJ shall nod[y in writiog the responsible authoritp dacribin;the nature of the disagreement. The responsibie authority shall within 30 days either: (a)correct the data[ound to be inaccurate or incoaplete and attempt to noti(y pasi recipients of inaccurate or incomplete data,including recipients named b�-the individual;or(b)nodfy the individual[hat he believes the data to be correct. Data in dispute shaii be disclosed only if the indi�idual's statement of disaareement is included with the disclosc�data. The determination of the responsible authority ma��be appealed pursuant to the provisions of the administrative procedure act relating to contested cases. D�T�PRIVACY AD�TSORY In accordance with NI.S.13.04,Subd.2,"Ri�hts of subjects of data",we�vould li�:e to inform you that}-our request for a permit or license from the City of Orono or any of its departments may reqaire you to furnish certain private or confidential information. You are notified that: 1. The information you furnish will be used to determine�-our qualification for the permit or license requested. 2. You may refuse to supply data,but refusal may require that the Cit�-deny the permit or license. 3. The information may be shared�vith other local,state or federal agencies to the estent necessar�-to process the permit or license. 4. If your requested permit or license requires Council action to approi-e, some information may become public. 5. You have certain rights under�I.S. 13.04(a��ailable upon request) to re�-ie�r•private data on�•ourself. 6. Your full name is required to process this application or permit. l � � ��t,.� �� `� l _ - . i �, r < First �Iiddle Last � �•�� ;� , <<�� t� ;�•r.-k�� <<� l�� C,� r Address �y v� "� t- � � Ci L�` 't � ' r �l�� 5.S j r�f % i -=' - Ll �r j _j L j �, % State Zip Phone I understand my rights as stated above. (� % � _ ' _ �.«, :.� <� �.�� , � `� Signature