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Scc.13.04 RIGk[TS OF SUI3JECT5 OF UATA Subd. l. Type of data. The righ[s of individual on whom the data is slored or to be stored shall be as set forth in this section. Subd.2. Information required to be given individual. An individual asked to supply private orcontidential data concerning himselfshall be informed of (a)the purpose and intended use of the requested data wiUlin the collecting state agency,political subdivision,or statewide system;(b) whether he may refuse or is Iegally required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidential data;and(d)the identity ofodier persons or entities authorizcd by state or federal law to receive the data.This requirement shall not apply when an individual is askcd to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcemenl officer. "Phe commissioner of revenue may place die notice required under this subdivision in the individual income tax or property tax refund instructions instead of on those fonns. SuUd.3. Access to data by individuaL Upon request to a responsible authority,an individual shall be infonned whether he is die subjectof stored data on individuals,and whe[her it is classified as public,private or confidentiaL Upon his further request,an individual who is Nte 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 die content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data nced not be disclosed to him for sia months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authority shall provide copies ofthe private or public data upon requezt by the individuai subject ofthe data. The responsible authority may require the rcqucsting person to pay the actual costs of making,certitying,and compiling thc copies. The responsible authority shall comply immediately,if possible,with any request made pursuantto this subdivislon,or within tive days of the date of the request,e�cluding Saturdays,Sundays and legal holidays,if imtnediate compl iance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an additional tive days within which to comply with the request,excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not acciirate or completc. An individual may contest the accuracy or comple[encss of publ ic or private data concerning himselE To excrcise this right,an individual shall notity in writing the responsiblc authority describingthe nature ofdie disagrcemen[.1fie responsible authority shaU within 30 days either (a)correct the data found to be inaccurate or incomplete and attcmpt to notify past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he be�ieves the data lo be correcL Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of thc responsible authority may be appcaled pursuanl to thc provisions ofthe administrative procedure act relating to contested cases. DATA PRIVACY ADVISORY In accordance with M.S. 13.04,Subd.2,"Rights of subjects of data",we would lihe to infonn you that your rec�uest for a perniit or license from the City of Orono or any of its departments may rcquire you to furnish certain private or confidential information. You are notified that: 1. The information you furnish will be used to detennine 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 pe�mit or license. 4. tf your requested permit or license requires Council action to approve,some inforn�ation may become public. 5. You have certain rights uiider 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. First Middle Last Address City Statc 7,ip Phonc I understand my rights as stated above. ';ZR/L� � 5ignxture Reset Form 32