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i • • Sec.13.04 RIGHTS OF SUB.TECTS OF DaTA Subd. 1. Type of data. The righrs of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Information reqtirired to be given individual. An individual asked to supply private or co�denaal data concerning hicnself shall be informed of: (a)the purpose and intended use of the requesced data within the collecang'state agency,poliacal subdivision,or sratewide system; (b)whether he may refuse oY is legally required to supply the requested data;(c)any lrnown consequence arising fmm his supplying or refusing to suppty priva[e or confidendal data;and(d)[he identiry of other persons or enrities auchorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesrigadve dara, pursuant to secdon 13.82, subdivision�, to a law enforcement ofFicer. The commissioner of re�enue mav place the nodce reauired under this subdivision in the individual income tax or proper[v tax refund instructions instead of on those forms. Subd. 3. Access to data by individual. Upon reques[to a responsible authority,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 request, an individual who is the subject 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 content and meaning of[hat data. Afrer an individual has been shown the private data and informed of ics meaning,ihe data need not be disclosed to him for six months thereafrer unless a dispute or acrion pursuan[to this secdon is p�nding or additional data on the individual has been collected 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 requesting person to pay the actual cosu of making, certifying, and compiling the copies. The responsible authoriry shall compty immediately, if possible, with any request made pursuant to this subdivision,or within five days oi the date of the request,excluding Samrdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comp(y with the request within that time,he shall so inform the individual,and may have an additional five days within which to 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 o�completeness of public or pri�•ate data conceming himself. To exercise this right,an individual shall notify in wridng the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either. (a)correct the data found co be inaccunte or incomplete and attempt to nodfy past recipienu of inaccurate or incomplece data, inciuding recipients named by the individual; or(b)notify the individual tha[he believes the data to be correct. Data in dispu[e shall be disclosed only if the individual's statemeat of disagreement is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the admuvstrarive 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 reauest 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 determine your qualification for the pemut or license requested. 2. You may refuse to supply data, but refusal may require that the City deny the pemut 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 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. (. Your full name is required to process this application or permit. �� � ��. �/�j `'`" �Y�--� First Middle Last � c % S � � ��- � � Address I L' " G '�1/`5 v �ti�i t 1 �- -�S�.? , City Sta�e ZiP Phone I understand my rights as stated ab ve . � � � Signamre �