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Sea13.04 RIGHTS OF S[lBJECTS OF DATA Subd. 1. Type of data. The righ�s of individual on whom the data is srored or rn be stored shall be as set focsh in this secdon. Subd.2. Information req�rired to be givea individual. .1n individual asked to supply private or confidenrial data concerning himself shall be informed of: (a)the purpose and inrended use of che iequesud data wichin the collecdng S-tatt agency,polirical subdivision,or statewid�system; (b)wherher he may refuse oY is legally required to suppiy the cequested data:(c)any known coauqueace arising from his suppiying or refusing to supply privace or confidendai dara;and(d)the idenriry of ocher persons or entides auchorized by stare or federal law to receive rhe data. This requirement s6a11 not apply when an individual is asked to supply ia��esdgadve dam,pursuant to secrion 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of re�enue mav pla--the noace tewired under this subdivision in the individual income tax or propertv taz refund insttucdons inscead of on those forms. 5ubd.3. Access to data b�individuai. Upon rcquesc to a responsible authoriry,an individual shall be informed whether he is the subjecc of stored data on individuals,and whether it is class�ed as public, private or confidendai. lipon his further request,an individual who is the subject of stored privace or pubiic data on individuals shall be shown che dara wichouc any charge to him and;if he desires,shall be informed of[he content and meaning of chat data. After an individual has been shown the privace data and informed of ics meaning,the data need not be disclosed ro him for six months thereafter unless a dispute or action pursuanc to [his ucdon is pending or addidonal data on the individual has been collected or creaud. The responsible authoriry shall provide copies of dse priva[e or public data upon request by the individual subject of che data. The responsible au[horiry may mquire the requesdng person[o pay the acnial costs of making,cerdfying,and compiling the copies. The responsibie aurhoriry shall comply immediately,if possible,wich any requesc made pursuant to this subdivision,or within five days of the date of the requesc,exciuding Saturdays.Sundays and legal holidays,if immediate compliance is not possible. If he cannoc comply with the request within fiat time,he shail so inform the individual,and may have an addidonal five days within wluch 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 or completeness of public or pri�•ate data conceming himself. To exercise[his righG an individual shall nodfy in writing rhe nspoasible authoriry describing the nature of the disagreement. �'he responsible authoriry shall within 30 days ei�er: (a)correcc che darn found to be inaccurdtL or incomplece and attempt to nodfy past recipienu of inaccurate or incomplece data, including recipienrs named by rhe individual;or(b)notify the individual that he believes[he data to be correct. Data in dispute shall be disclosed only if the individual's sratemenc of disagreement is included wirh the disclosed data. The determinadon of the responsible auchoriry may be appealed punuant to the provisions of[he adminisaarive procedure act relaang to contested cases. DATA PRNACY 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 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 o[her local, state or federal a�encies 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. �, You have certain ri;hts 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. ��n�►1�� 1� �T�� First �11dd1z Last �(�3� G�9t--�,��r �° ,�.�' �dd�ss �r/l� .SS��G � i��►��,�,�� -- - C�ry Stace Zip Phone I understand my ri�hts as stated bove. Signamro