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) Sec.13.04 RIGHTS OF S[JBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stoced or to be stored shall be as set forth in this section. Subd.2. Information req�rired to be given iadividual. An individual asked to supply private or confidendal data concerning himself shall be informed of: (a)the purpose and intended use of the requesced data within the collecdng 3tate agency,poliacal subdivision,or statewide system; (b)whether he may refuse oY is legally required to supply the requesud data;(c)any lrnown consequence arising from lus supplying or refusing to supply private or confidential data;and(d)the idenriry of o[her persoas or enudes authorized by state or federal law to receive the data. T'his requirement s6a11 not apply when an individual is asked to supply investigadve dara, pursuant to secdon 13.82,subdivision 5,to a law enforcement officer. The commissioner of re�enue mav place the nodce required under this subdivision in the individual income rax or_prooertv tax refund instructions inscead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of swred data on individuals,and whether it is classified as pubtic, private or confidenaal. Upon his further request,an individual who is the subject of srorod private or public data on individuals shall be shown the dara wirhout any charge to him and,-if he desires,shall be informed of the content and meaning of rhat data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six monchs theroafter unless a dispute or action pursuanc to this secdon is pending or addidonal data on the individuai has been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subjecc of the data. The responsible authority may requiro the requesting person to pay the actual cosu of making,certifying,and compiling the copies. The responsible authority shall comply immediately, if possible,with any request made pursuant to this subdivision,or within five days of the date of ihe request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within diat 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 accucacy or completeness of public or private data concerning himself. To exercise chis right,an individual shall nodfy in writing the responsible authority describing�he naturo of the disagreement. The responsible authoriry shall within 30 days ei[her: (a)cornct the data found to be inaccurate or incompiece and attempt to nodfy past recipienu of inaccurate or incomplete data, including recipients named by the individual;or(b)noafy the individual thac he believes the dara to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The deurminarion of the responsible au[hority may be appealed pursuant to the provisions of the administrarive 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 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 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. ,�'.[C ' 1� Fi st Middle Last �:� ,� f�0�1� �Yl'� ��-r[� . - i��v Address rYlvvnD �'l� �� y �s�--�f71-�d�� City Sm� Zip Phone I understand my rights as stated above. Sig e