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. � � • r r , Sec.13.04 RIGHTS OF SLTBJECTS OF DATA Subd. 1. Type of data. The rights of individual on whom�e data is stored or to be stored shall be as set forth in this secdon. Subd.2. Information r�mired to be Qiven individual. An individual asked to supply private or confidential darn concerning himself s�all be informed of: (a)the purpose and intended use of the requested data within the collecting�ttate agency,political subdivision,or statewide system; (b)whether he may refuse or is legally required w supply d►e teqttested data;(c)any lrnown wnsequence arising from his supplying or refusing to supply � private or confidential data;and(d)the identiry of other persons or entities authorized by state oc federal law to receive the data. This requirement shall notapply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement officer. � �e�.,,miccioner of revemie mav nlace tt►e notice reauired under this sutttiivision in the individual income tax or propertv tax refund � I instructions instead of on ffiose forms. I Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be informed whether he is the subject i of stored data on individuals,and whether it is classified as public,private or confidential. Upon lus further request,an individual who is the subject i of stored private or public data on i�ividuals shall be shown die data without any charge to him and,if he desires,shall be informed of the content I and meaning of that data. After an individual hes 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 action pursuant ro this secdon is pending or additional data on the individual has heen collected or created. � The responsible authority shal!pmvide copies of the private or public data upon request by the individual subject of the data. The respons�le authority may require the requesting person to pay the acwal costs of making,certifying,and compiling the copies. The responsible authority shall comply immediately,if poss�le,with any request made pursuant to this su�livision,or within five days of the da�of the request,excluding Sawrdays,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 wluch to comply with the request,excluding Saturdays, S�ndays and legal holidays. . Subd.4. Proced�e when data 4s not acc�ate or complete. An individual may contest the accuracy or completeness of public or private ' data concerning himself. To exercise this right,an individual shall notify in writing the responst'ble authority descriUing the nawre of the disagreement. The responsible audiority shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of i inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he helieves the data to be correcG Data ', in dispute shall be disclosed only if the individual's statement of disagreement is included with�e disclosed data. I The determination of the respons�le authoriry may be appealed pursuant to die provisions of the administrative procedure act relating to contested cases. � I DATA PRIVACY ADVISORY �I In accordance with M.S. 13.04,Subd.2, "Rights of subjects of data",we would like to inform you that your request I� 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 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 upon request) to review.private data on yourself. 6. Your full name is required to process this application or permit. ,�� ,b��v .11��'s �.��• First Middle Last /AG S ��L� Address U/� /h.� �-�3 l�/ •�7S' ��8� City State Zip Phone I understand my rights as tated above. �,/��G� <.YL«'�-- �L�Q .s�.G� Signature