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� - .�i - Sec.13.04 RIGHTS OF S[JBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom the dara is stored or to be stored shall be as set forth in rhis section. Subd.2. Information reqirired to be given individual. An individual asked W supply private or confidendal dara conceming himself shall be informed of: (a)the purpose and intended use of the requesud dara wirhin the collecting�tate agency,polidcal subdivision,or statewide sysum; (b)whether he may refuse ot is legally required co supply rhe requested data;(c)any lrnown consequence arising from his supplying or refusing to supply priva[e or confidenrial data;and(d)the idenary of other persons or enrides authorized by state or federat law to receive the data. T'his requirement shall not apply when an individual is asked to supply invesagadve data,pursuanc to secrion 13.82, subdivision 5,to a law enforcemen[o�cer. The commissioner of revenue mav place the noace rewired under this subdivision in the individual income tax_or Dropertv tax refund instrucdons instead of on those forms. Subd.3. Access to data by individual. Upon requesc co a responsibte authoriry,an individual shall be informed whether he is the subject of swred data on individuals,and whe�her it is classiFied as public, private or confidenaal. Upon his further request,an individual who is the subject of swr�d private or public dara on individuais shall be shown the data wichout any charge to him and;if he desires, shall be informed of the content and meaning of that data. Aher an individual has been shown rhe private data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acaon pursuanc to chis secaon is pending or addidonal data on the individual has been collected or created. The msponsible authority shall provide copies of the privace or public data upon request by the individual subject of the data. The responsible authority may require the requeseng person to pay the actual cosu of making,certifying,and compiling the copies. The responsible authority shall compiy immediacely,if possible,with any re4uest made pursuant to this subdivision,or within five days of the date of rhe request,exctuding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so inform the individual,and may have an addiaonal 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 pubiic or private data conceming himself. To exercise chis right,an individual shail nodfy in writing the responsible authoriry describing the nature of the disagreement. The responsible authoriry shali within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of inaccurate or incomplete data, including recipients named by[he individual;or(b)nodfy the individual thac he believes the data to be correcc. Daha in dispute shall be disclosed only if the individual's statemenc of disagreement is included wich rhe disclosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the administradve 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 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 detemzine your qualification for the permit or license requested. 2. You may refuse to supply data, buc 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 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. Your full name is required to process this application or permit. e�r �\:n First Middle �5L �4�`� � '��.�\< �..,�.� — Address _ �`� � � . � ss C�ty Sta� Z�p Phone I understand my rights as stated above. Signature