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Sec.13.04 RIGHTS OF S[JBJECTS OF DATA Subd. 1. Type of data. The righrs of individual on whom[he data is stored or to be stored shall be as set focth in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidendal data conceming himself shall be informed of: (a)the purpose and incended use of che requesced data within the collecting§tate agency,polidcal subdivision,or stacewide sysum; (b)whether he may refuse ot is legally required to supply the cequested data;(c)any Irnown consequence arising from his supplying or refusiag to supply priva�e or confidendal data;and(d)[he idenriry of o[her persons or enddes auchorized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply invesdgadve data,pursuant to secdon 13.82, subdivision 5, to a law enforcement o�cer. The commissioner of revenue mav place the norice required under this subdivision in the individual income tax or propertv taz refund instrucdons instead of on[hose 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 stored data on individuals,and whether it is classified as public, privace or confidential. Upon his further request,an individual who is the subjecc of stored private or public dara on individuals shal►be shown the dara wi[hout any charge to him and, if he desires, shall be informed of the content and meaning of[hat data. After an individual has been shown[he private data and informed of its meaning,che data need not be disclosed to him for six months thereafter unless a dispute or acdon pursuant to this secaon is pending or addidonal data on the individual has been collected or created. The responsible authority shalt 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 costs of making,certifying,and compiling[he copies. The responsible authority shall comply immediately,if possibie, with any request made punuant to this subdivision,or within five days of the date of the requesc,excluding Saturdays,Sundays and legal holidays,if immedia[e compliance is not possible. If he cannot comply with the request wichin that time,he shall so inform the individual,and may have an addidonal 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 or completeness of public or private data conceming himself. To exercise chis right,an individual shalt nodfy in wridng the responsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipients of inaccurate or incomplete data, including recipiencs named by che individual;or(b)notify the individual that he believes rhe data to be correct. Data in dispute shail be disclosed only if the individuai's statement of disagreement is included with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the administrative 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 fumish certain private or confidential information. You are notified that: 1. The information you furnish will be used to determine your c}ualification 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 pemut or license. 4. If your requested permit or license requires Council action to approve, some information may become public. g. 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. �l�r.cn 1'�c.A-B�- � , � Middle Last F�n�1�� l 1 �Jl.�6c N n� �—iD - tN�� Addre��n � �� — 1 `_F��r••r �ity State Zip Phone I understand my rights as stated above. � ��:,� Signature