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Sm.13.04 RIGHTS OF sumcrS OF DATA ' Subd. I. Type of data. The rights of Individual on whom the data Is sw or to be stored shall be as set forth In this section.. Subd.2. Information required to be given individual. An individual ask to supply private or confidential data concerting himself shall be informed of. (a)the purpose and Intended use of the requested data within the Boll citing late agency.political subdivision,or statewide system; (b)whethcrhe may refuse oY is legally required to supplythe requested data;(c)any into consequence arising from his supplying or refining to supply private or coaSdentiaI data;and(d)tete Identity of otherpenaas oreaddes'audiorized b sate orfederal law to receLye the data. This requirement shall not apply when an individual is asked to-supply irivesdgadve dam,pursuant to section 13.82,subdivision S.m a law enforcement officer. The commissioner of revenue may lace the node_reauired under this su ivision in the individual Income tax or roerty tax refund Instructions Instead of on those forms. Subd.3. Access to data by individual. Upon request to a responsible au odd.an Individual shall be informed whether he is the subject of stated dam on individuals,and whether it is classified as public,private or confide tial. Upon his 8lrther request,an Individual who is the subject of stored private or public dam on individuals shall be shown the dam without any c e to him and;if he desires,shall be informed of the content and meaning of that data. After an Individual has been shown the private dam and inf rmed of Its meaning.the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant to this section Is pending or ddidonal dam on the individual has been collected or created. The responsible authority shallprovide copies of the private or public data upon reques by the Individual subject of the dam. The responsible authority may require the requesting person ro pay the actual costs of making,certifying,and mpiliing the copies. The responsible authority shall comply immediately,if possible,with any quest trade pursuant to this subdivision,or within five days of the date of the request.excluding Saturdays.Sundays and legal holidays,If Immediate mpiiance 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 da r�within which to comply with the request.excluding Saturdays, Sundays and legal holidays. Subd.4. Procedure when data is not accurate or complete. An iadivido may contest the accuracy or completeness of public orprivate data concerning himself. To exercise this right,an Individual shall notify In writing th respoasibte authority describing the nature of the disagreement The responsible authority shall within 30 days either. (a)correct the data found to b Inaccurate or incomplete and attempt to notify past recipients of Inaccurate or incomplete data.Including recipients named by the individual;or(b)a tify 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 Inc nded with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act relating to contested cases. DATA PRIVACY ADVSORY In accordance with M.S. 13.04,Subd.2, "Rights of subjects o�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 determine your qualification for the permit or license requested. 2. You may refuse to supply data, but refusal may req ire that the City deny the permit or license. 3. The information may be shared with other local,stat or federal agencies to the extent necessary to process the permit or license. 4. If your requested permit or license requires Counc action to approve, some information may become public. S: You have certain rights under M.S. 13.04•(availabl upon request) to review private data on•yourself. 6. Your full name is required to process this applicad a or permit. l=ust btiddte Last • //l X1-57 &()1-0 .v G�4� LAN Address ttct,P pr Ale City Slue Zip Phone I understand my rights as stated above. Signature I I '