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�� . Sec.13.04 RIGHTS OF SUBJECTS OF DaTA Subd. 1. Type of data. 'Ihe rights of individual on whom rhe data is stored or to be stored shali be as set forth in this secdon. Subd.2. Information reqirired to be given individual. An individual asked to supply private or confidearial data concerning himself shall be informed of: (a)the pucpose and in�ended use of the requesud data wirhin the co(lecdng Ytate agency,polidcat subdivision,or statewide rystem; (b)whether he may cefuse oY is legally required co supply the requested data:(c)any lrnown coasequence arising from his supplying or refusing to supply • private or confidendal dara;and(d)che idenary of other persoas or encides aurhorized by state or federal law to receive the data. 'I'his requirement shall not apply when an individual is asked to supply invesdgadve dara,punuant to secdon 13.82,subdivision 5, to a law enforcement o�cer. - The commissioner of revenue mav place the noace reauired under this subdivision in the individual income tax or propern tax refund instrucrions inscead of on chose forms. Subd.3. Access to data by individual. Upon requesc w a responsible auehoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whecher it is classified as public,priva[e or confidenaal. Upon his further request,an individual who is the subject of stored private or public dara on individuals shall be shown che dara wichout any charge to him and;if he desires,shall be informed of the contenc and meaning of rhat data. After an individual has been shown[he private dara and informed of iu meaniag,rhe dara need not be disclosed w him for six mon[hs thereafter unless a dispute or acaon pursuanc to chis secrion is pending or addidonal dara on rhe individua!has been coliected or creared. The rosponsible au[horiry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the aceual cosu of making,cerafying,and compiling the copies. The responsible au[horiry shall comply immediately, if possible,with any request made pursuant to chis subdivision,or within five days of the date of[he nquest,excluding Saturdays.Sundays and legal holidays,if immediace compliance is not possible. If he cannot comply wirh the request within fiat time,he shail so inform[he individual,and may have an addirional five days within which to compiy wirh 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 compieteness of public or private data conceming himself. To exercise chis right,an individual shall noafy in writing the nsponsible authoriry describing the nature of the disagreement. The responsible authoriry shall within 30 days either: (a)correct rhe data found to be inaccurdte or incomplete and attempt to nodfy past recipients of inaccura[e or incomplete data, including recipients named by che individual;or(b)noafy the individual thac he believes the dara to be correct. Data in dispute shalt be disclosed only if[he individual's statement of disagreement is included wich�he disclosed data. The decerminaaon of the responsibte auchoriry may be appealed punuanc to the provisions of[he adminisaadve procedure act retadng to contesud 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 eztent 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. I3.04 (available upon request) to review private data on yourself. 6. Your full name is required to process this application or permit. First yfiddle Last Address . Ciry Stam Zip Phone I understand my rights as stated above. Signacure