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, � f Z Sea 13.04 RlGHTS OF SUBJECTS OF DATA � } � , Subdivrsion 1. Type ojdata The righls of individua!on whom the data is stored or to be stored sha11 be as set forth in this section. Subd.2. Information required to be given individuaL An rndividua[asked to supply private or confidential data concerning hrmself shall be informed of (a)the purpose arrd intended use oJthe requested data within the collecting state agency,politica!subdivision,or statewide systene;(b)whether he may refuse or rs lega[ly required to suppfy the requested data;(c)arry known consequence arising from his supplying or refusing to supplyprivate or confidentia[data;and(d)the identity oJolherpersons orentities authorized by state orfederallaw to receive the data. This requiremext shall not apply when an individual rs asked to supply irrvestigative da1a,pursuant to section 13.82, subdivrsion 5, to a law enjoscement o�cer. The commissioner of revenue mav place the notice reauired under this subdivisron in the indrvidua!income tax or nroperty tax refund instructiaxs irestead of on those forms. , Subd.3. Access to datu by individur� Upon request to a resporrsrble authority,an individual shall be informed whether he is the subject of stored data on rndividuals,and whether it rs classifred as public,private or confrdential. Upon his further request,an individua!who is the subjec�of slored prrvate or public data on rndividuals shall be shown the data without any charge to him and,rf he desrres,shall be informed of the conlext and meaning of that data.'After an individua!has been shown the private data arrd informed of its meaning, the data rteed not be disclosed to him for six months thereafter un/ess a dispute or action pursuant to this sectron is pending or additional data on the individua!has been collected or created. The responsible authority shall provide copies of the prrvate or public data upon request by the individua!subject oJ the data. The responsible authority may require the requesting person to pay the actual costs of making,certifying,and compiling the copies. The responsible authority shall comply immediately,ef possible,with arry request made pursuant to this subdivision,or within five days of the date of the request,excluding Saturdays,Sundays and legal holidays,rf immediate compliance is not possible. If he cannot comply with the request within that time,he shall so injorm the individual,and may have an addrtional frve days within whrch to comply wrth the request,exc[uding Saturdays,Sundays and lega!ho[rdays. Subd.4. Procedure when data is not accurate or complete An individua!may contest the accuraty or completeness ofpubl ic or private data concernirrg himself To exercise this rrght, an individual shal!notify rn writing the resporrsible authority describing the nature of the disagreement. The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and atlemp�to not� past secipients of rnaccurate or incomplete data,including recipients named by the irrdividual;or(b)not�the individua[that he believes the data to be correct. Data in dispute shall be disclosed only rf rhe individua!'s statement ojdisagreement is included with the disclosed data. The determinalion ojthe responsible authority may be appealed pursuant to the provisions of the adminrstrative procedure act relating to contested cases. DATA PRLVACYADVISORY In accordance with M.S.13.04,Subd.1,'Rights ofsubjects ojdata"we wou/d like to injorm you thatyour reguestfor a perrnit or lrcense frbm the City of Orono or a�ry ojits departments may require y0u to furnish certain private or confrdentia!injormation. You are xotified that: 1. The rnformation you furnish will be used to determine your qualificatron for the permrt or lrcense 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 lieerrse. 4. Ijyour requested permit or license requrres Councrl action to approve,some information may become public. S. You have certain rights under M.S. 13.04(see following page)to review private data on yourself. 6. Your ferll name is required to process this application or permit. PLEASE PRINT .��y�/a,i�_ T� ��'� Firs— t � Middle Last �d�3 �� '� �r� Address _ .9rw�t��o,� /!�� ,�'1��'� �G✓r�/�s� -9 x�- City State Zip hone /understand my rights as sAated above. Srgnalure 10