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Sec.13.04 RIGHTS OF SITB.TECTS OF DATA Subd. 1. Type of data. The righcs of individual on whom[he data is stored or to be stored shall be as set forch in this sccdon. Subd.2. Information mq�red�a be given individual. An individual asked to supply privatP or confidential data concerning himsalf sha11 be informed of: (a)the purpose and incended use of[he reyuested data wichin the collecring'state agency,poGdcal subdivision,or sratewide sysaem; (b)whecher he may refuse or is legally requued to supply the requested dara:(c)any known�oasequence arising frvm his suppiying or refusing to suPP�Y privace or co�denaal data:and(d)the idenriry of other persons or entiries authorized by state or federal law to receive the data. This requirement`►+ati noc apply when an individual is asked to supply invesagaave dara, pursuant co secuon 13.82,subdivision 5, ro a law enforcement officer. The commissioner of revenue mav lace the nocice re uired under this subdivision in the individual income rax or rocem raz refund instrucrions instead of on chose forms. Subd. 3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whe[her he is the subject of stored data on individuals, and whecher it is classified as public, private or confidenaal. Upon his fur[her request,an individual who is the subject of stored private or public data on individuals shall be shown the data withou[any charge to him and, if he desires, shall be informed of the content and meaning of that dara. Aher an individual has been shown the private data and informed of ia meaning,the data need not be disciosed to him for six monchs thereafcer unless a dispute or action pursuanc to this secrion is pending or addidonal data on the individual has been collected or creaced. The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of[he data. The responsible authoriry may require the requesting person to pay the actual costs of making, cerafying, and compiling the copies. The responsible authoriry shall comply immediately, if possible, with 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 reques[ within thac time,he shall so inform the individual,and may have an additiooal five days within which to comply with the requesc,excluding Sarurdays, Sundays and legal holidays. Subd.4. Procedure�vhen data is not accurate or complete. An individual may contest the accuracy or completeness of public or private data conceming himself. To ezercise this right,an individual shall notify in writing the responsible authoriry describing the narure of the disagreemen[. The responsible authority shall within 30 days either. (a)correct[he data found[o be inaccurate or incompte[e and atcempt ro nodfy past recipients of inaccurate or incomplete data, including recipients named by the individual; or(b) notify the individual that he believes[he data to be correct. Data in dispute shalt be disclosed only if the individual's statement of disagreement is included with the disclosed data. The determinaaon of ehe responsible authority may be appealed pursuant to the provisions of the adminisuadve procedure act relating to concesced 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 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 fumish 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. become 4. If your requested pernut or license requires Council action to approve, some information may public. j, 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. �� -,� \ L da-~�-C- ��'� � Lasc F�� Vliddle � �� Addre s /"!� � (�_ U`7J S� ��'�- � "� State Zip Phone ��ry � �z �--�5-t�� I understand my rights as stated above. �� Signature