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Sec.13.04 RIGHTS OF S[JBJECTS OF DaTA Subd. 1. Type of data. '!he rights of individual on whom the data is stored or to be stoced shall be as set forth in this secaon. Subd.2. Information reqlrired to be givea individual. An individual�ked to supply private or confidendal dara concerning himself shall be informed of: (a)the purpose and intended use of the reques�ed data within the collecdng state agency,political subdivisioa,or statewide system; (b)whether he may refuse oY is legatiy requ'ued to supply the requesud data;(c)any Imown consequence arising from his supplying or refusing to supply private or confidenaal data;and(d)the idendry of other persoat or enrides authorized by state or fede�al law to receive the data. This requirement shall not apply when an individual is asked to supply invesagadve data,pursuaat to secdon 13.82,subdivision S,to a law enforcement officer. The commissioner of revenue mav piace the noace iewired under this rubdivision in the individual income taz or orooertv tax refund instcuctions instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible auchoriry,an individual shall be informed whether he is the subject of stomd data on individuals,and whe[her it is classified as public,private or confidenoal. Upon his furtber 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 content and meaning of chat data. After an individual has been shown[he private data and informed of irs meaning,the data need not be disclosed to him for six monrhs thereafur unless a dispute or acdon pursuanc to[his secdon is pending or addidonal data on the individual has been collecud or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authoriry may require the requesring person to pay the acaai costs of making,certifying,and compiling the copies. The responsible authoriry shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days of the date of the nquest,excluding Saardays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that tune,he shall so inform the individual,and may have an addiaonal five days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure whea data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data conceming himself. To exercise[his right,an individual shall noafy in wricing the responsible authority describing�h�nature of the disagreement. The responsible authoriry shall within 30 days either: (a)cornct the data found ro be inaccucate or incomplete aad attempt to noafy past recipienu of inaccurate or incomplete data, including recipients named by the individual;or(b)notify the individual that he believes the data w be correcc. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The decerminadon of the responsible auchoriry may be appealed pursuant to the provisions of the administrsrive procedure act nlating 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 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 extent necessary to process the pemut 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 perm.it. �tu�,l.� l "U1'��I✓ g�� / �� Middle Last p � �Ct,,�o-r�l ` Address �a s N o n� N �5:�� j s.�-��/5-o /b 5 C��y State Zip Phone I understand my rights as stated above. �� .� �� Sign�ature