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. . � Sec.13.04 RIGHTS OF SUBJECTS OF DATA Subd. 1. Type uf data- 'I!►e rights of individual on whom the data is srored or m be stored s1�all be as set fonh in this secdon. Subd.2. Information req�rired to be given individual. An individual asked to supPlY Private or wnfidential data conceraing himsedf sha11 be mformed of: (a)the piupose amd inte�ed use of the requested data within the collecting�late agency,Polidral sabdivision,or staoewide sysoem: (b)whether he may refuse or is leSallY requi�d to supply the requested data;(c)anY l�wn consequence azising from his supplying or refusinB m svQPIY private or confidendal data:and(d)the idendry of other peisons or entides authorized by state or federsl]aw to receive the data. This requireme�shaII nat apply when an individual is asked co supplY invesdgaave data,pursuanc to secdon 13.82,subdivision 5,ro a law enforcement officer. The commissioner of revenue ma lace the noace re ired under dus subdivision in the individual iacome taz or ro m tax refund insauctions instead of on those forms. Subd.3. Access to data by iadividual. Upon request m a responsible authority.an individual shall be infora►ed whether he is the sabject of soored data on individuals,and whether it is classified as public,private or confidendal.��er d��I��of the contenc of stored private or public data on individuals shall be shown the data without aay charg and meaning of that data. Afrer an individual has been shown the private data and informed of it�meaning,the data need not be disclosed w him for six moaths theceafrer unless a dispute or acrion pursuant to tlus secdon is pending or additional data on die individual has been collected or created. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The resgonsible authoricy may require the cequesting person to pay the actual casu of making,certifYu►S.and compiling the copies. The responsible auchority shall comply immediacelY.if possible,with any request made pursuant to this subdivision,or within five days of the date of the requesG excluding Saturdays,Sundays and legal holidays,if immediace compiiance is not possible. If he cannot compiy with the requesc w;thin thac time,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,ezcluding Saturdays, Sundays and legat holidays. Subd.4. Procedure when data u not accurate or complete. An individuai may contes�the accuracy or completeness of public or private data concerning himself. To ezercise this righ4 an u►di�idual shail noafy in writing the resgonsible authoriry describing the nature of th�Rc r��o The responsible authority shall wirhia 30 days eidier. (a)correcc the data found to o��e.��°.ivi ual�hac he believ�esmthe data to be correct Dara iaaccurate or incomplete data,including recipients named by the iadividual:or(b) �Y in dispute shall be disclosed only if the individual's statement of disagree�me u��t��pro�ions of the adminisccative procedure act relating to The detecminadan of the responsible authority may Ue apPea� p contested cases• DATA PRIVACY AD�'ISORY In accordance with M.S. 13.04,Subd.2, "Rights of subjects of data",we would likeou to furnish certain private or for a permit or license from the City of Orono or any of its departments may require y 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 requu'e 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. . g, You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. (, Your full name is required to process this application or permit. � �LL � M�c � MGGVI�.A `r Middle � F,nt o T�-1 S N a R.� D It i �!� 40 �+- I nl ° Address � �J . �S 3 6 4- 6 Z G S3 M D V � S�� Zlp Phone cicy I understand my rights as stated above. c 3ignaaire