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� Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth in this section. Subd.2. Infonnation requu•ed to be given individual. An individual asked to supply p�ivate or confidential data concerning himself shall be infonned of: (a)the pwpose and intended use of the requested data within the col(ecting state agency,political subdivision,or statewide system;(b) whether he may refuse or is legally 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 of other persons or entities au[horized by state or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement o�cer. +�,; The commissioner of revenue mav place the notice required under this subdivision in the individual income tar or pronertv tax refund '"4' instructions instead of on those fonns. Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be infonned whether he is the subject of stored data on individuals,and whethc��it is classitied as public,private or confidentiaL Upon his further request,an individual who is the subject of stor�'H private or public data on individuals shall be shown the data without any charge to him and,if he desires,shall be infonned of the content and meaning oY that data. After an individual has been shown the private data and infonned of its meaning,the data need not be disclosed to him for six ;�tnonths thereafter uniess 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 of the private or public data upon request by the individual subject of the data. T'he responsible authority may require the re�uesting person to pay the actual costs of making,ceitifying,and compiling[he copies. The responsible authority shall compty immediately,if possible,with any request made pursuant to this subdivision,or within five c43ys of the "" date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply wi[h the request within that time,he shall so infonn 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 accurate or complete. An individual may contest the accuracy or completeness of public or p�ivate data concerning himselE To exercise this right,an individual shall notify in writing the responsible authoiity describing the nature of the disag��eement. The responsibfe authority shall within 30 days either: (a)con�ect the data found to be inaccurate or incomplete and attempt to notity past recipients of inaccurate or incomplete data,includi�recipients namexl by the individual;or(b)notify the individual that he believes[he data to be con•ect. Data in dispute shall be disclosed only if the individuaPs statement of disagreement is included with the disclosed data. The detennination of the responsible authority may be appealed pursuant to the provisions of the administ��ative procedure act relating to contested cases. +, ,w 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 pernlit 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 Cit,�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. 6. our full name is required to process this application or permit. � ' 61 t�.� ��1�,"� First Nliddle Last �5 I � NG��-h �1�m�� r�'��e Address �ro�o �ti 55 ��1 ��-`�7�'�� City Statc Zip Phon/e_ I understand my rights as stated bove. �' v lZ- 7/v+�� o� ,_ Signature