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Sec.13.0a RIG}I7'S OF SUBJECTS OF DATA Subd.'1. Type of data. The ri�hts of individual on whom the data is stored or to be stored shall be as set foRh in this section. Subd.2. Information required to be given individual. An individual asked to supply private or contidential data concerning himselfshall be informed o£ (a)the purpose and inlended use of d�e requested data within die collecting state agency,political subdivision,or statewide system;(b) �vhether he may refuse or is legally required to supply the requested data;(c)any kno�wi consequence arising from his supplying or refusing to supply private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data.This requirement shall not apply when an individual is asked to supply investiga[ive data,pursuant to section 13.82,subdivision�,to a law eni'orcement officer. The commissioner of revenue ma�allce the notice required under this subdivision in the individual income tax or oroaertv tax refimd instruc[ions instead of on those fonns. Subd.3. Access to data by individual. Upon request to a responsiUle authority,an individual shall be infonned whether he is the subject of stored data on individuals,and whether it is classitied as public,private or contidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data without any charge to him and,if he desires,shall be informed of the content and meaning of tha[data. After an individual has been shown the private data and informed of its meaning,the data need not be disdosed to him for si� months thereatler unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The responsible authority shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority map require d�e requesting person to pay the actual costs of making,certitying,and compiling the copies. The responsible authority shal I comply immediately,if possible,�vith any request made pursuant to this subdivision,or within tive days of the date of the request,exduding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request within that time,he shall so infonn the indi�idual,and may have an additional five days��ithin which to comply ti ith the request,e�cluding Saturde�s. Sundays and le�al holidays. Subd.4. Procedure when data is notaccurare or complete. An individual may contestthe accuracy or completeness of public or private data concernin�himself. To exercise this right,an individual shall notity in writing the responsible authority describing the nafure of[he disagreement The responsible authority shall within 30 days either. (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of inaccurate or incomplete data,including recipients named by the individual;or(b)notity the individual that he believes the data to be correct Dafa in dispute shall be disclosed only if the individual's statement of disaareement is included with the disclosed data. The determination of the responsible authority may be appealed pursuant to the provisions of the administrahve procedure act relatin�to contested cases. DATA PRIVACY ADVISORY ln 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 infonnatioi�. . You are notified tliat: 1. The infonnation you furnish �vill 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 necessaiy to process the permit or license. 4. If your requested pennit or license requires Council action to approve, some infor�nation may become public. 5, You have certain rights under NLS. 13.04(available upon request)to review private data on yourself. 6. Your full name is required to process this application or pennit. , �t��` � �o h►'� so � First �'liddlc L:�st ��,3 `� � � �nP �ddress C� �o no � r� .s.�-��6 ��a�.3o��-�aa �- Cih, ' Statc Zip Phone 1 unde�stand n v rights as st�ted above. �� � �� ]„ _ Signa[urc Reset Fom> >'—