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a Sec.13.04 RIGATS OF SZJBJECTS 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. �nformatton required to be�tven individual. An individual asked to supply private or confidential data concerning himself shall be informed of: (a)die purpose and intended use of the requested data widrin the collectiag state agency,political subdivision,or statewide system;(b)whether he may refuse or is legally required to supply the requested data;(c)any lmown consequence arising from his supplying or refusing ro supply private or wnfide�ial data;and(d)the identity of other petsons or entities authorized by staoe or federal law to receive the data. This requirement shall not apply when an individual is asked to supply investigative data,pursuant to secdon 13.82, subdivision 5,w a law enforcement officer. The commissioner of revemie mav nlace the norice reauired under this subdivision in the individual income tax or nronertv tax refund instrucdons instead of on those forms. Subd.3. Acccss to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject of stored data on individuals,and whether it is classified as public,private or confidential. Upon his fuither request,an individual who is the subject of stored private or public data on individuals shall be shown ihe data withwt any charge w him and,if he desires,shall be informed of die content and meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for six monthc diereafter unless a dispute or actiott pursuant to this section is pei�ing or addidonal data on the individual has been collected or created. The respoasible audioriry sha(1 provide copies of the private or public data upon request by the individual subject of the data. The responsible au�ority may require the requesdng person to pay the actual costs of maldng,certifying,and compiling the copies. The responsible authoriry.shall comply immediately,if possible,widi any request made pursuant 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,and may have an additional five days within wlrich 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 private data coaceming himself. To exercise this right,an individual shall notify in writing the responsible authority describing iha�nature of the disagreemem. The responsble authoriry shall within 30 days either: (a)comct the data found to be inaccuiate or inco�lete and attempt to notify past recipiems of inaccurate or iacomplete data,including recipientc named by the individual;or(b)nodfy the individual that he believes the data to be correct. Data in dispute shall be disciosed only if the individual's statement of disagreement is included with tt►e disclosed data. The determinaaon of the responsible authority 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�ity of Orono or any of its departments may require you to furnish certain private or confidenrial information. You aze notified that: 1. The informarion 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 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 upan request)to review private data on yourself. 6. Your full name is required to process this application or permit. First Middle Last Address City State Zip Phone I understand my rights as stat ove. Signature � 6