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• � t Sec.13.04 RIGIiTS 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. Informatlon required to be given iadividual. An individual asked ro supply private or confidendai data concerning himself shall be informed of: (a)die purpose and inte�ed use of the requested data within the collecting state agency,political subdivision,or statewide system;(b)whether he may refuse or is legaUy required to supply the requested data;(c)any known consequence arising from his supplying or refusing to supply private or confidendal data;and(d)the idenaty of other persons or entiaes authorized by state or federal law to receive the data. T'his requirement shall not apply when an individual is asked to supply investigative data, pursuant to section 13.82, subdivision 5, to a law enforcement officer. The commissioner of revenue mav�lace the noece rewired under this subdivision in the individual income taz or orocertv taz refund insr„�5tions�nstead of on those forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is ctassified as public,private or confidendal. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown d�e darn without any charge to him and,if he desires,shall be informed of the content and meaning of that data. After an i�ividual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six months thereafter unless a dispute or acdon pursuant to diis section is pending or additional data on the i�dividual 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. The responsible authoriry may require the requesting person to pay the actual cosu of making,certifying,and compiling the copies. The responsible authority shall comply immediately,if possible,with any request made pursaant to this subdivision,or within five days of the date of the request,excluding 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,a�d.may have an additional f ve days Wtithin which to comply with the request, eincluding Satardays,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 private data co�eming himself. To exetcise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement. The responsible authoriry shall within 30 days either. (a)correct the data found to be inaccurate or i�omplete a�xl attempt to notify past recipients of inaccurate or ic�omplete data,including recipienu named by the individual;or(b)notify the individual that he believes the data to be correct. Data in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determination of the responsible authoriry may be appealed pursuant to the provisions of the 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 like to inform you that your request for a permit or license from the Gity of Orono or any of its departments may require you to fumish 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 shazed 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 pemut. t��cn J. ��.�c��,2 First Middle Last � q�o � �/''��t2��U l��l C Address �� t� `PYL4��1 L'� M �J S�' 3�1 fP�2,Q�t �•2$o Z C�h, $tyte Zip Phone I understand my rights as stated above. � Signamre 6