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� Sec.13.04 RIGHTSOF3UBJECTSOFDATA Subdivision 1. Type ojdata. The righls of individual on whom the data is stored or 10 be stored shall be as set forth in this seclion. Subd.2. Injofmation tequired to be given individuaL An indrvidual asked to supp/y private or confuiential data concerning himsel,f shall be informed of (a)!he purpose and rntended use of the requested data within the collecting state agency,political subdivisron,or statewide system;(bJ whether he may refuse or is legally required to suppfy the requested data;(c)airy known consequence arising from his supplying or refusing to supplyprivate or conf:dential data;arrd(d)the identiry of other persons or entiti¢s authorized by state orfederal law to receive the data. This requirement shall not apply when an irulividua!is asked to supply irrnstrgative data,pursuant to section 13.82, subdivision S,�to a law en,jorcement o�cen The commissioner ofrevenue mav nlace the notice reauired under this subdivision in the indivrdual income tax or nronertv tax refund instructrons instead ot on those forms. Subd.3.Access to data by individuaL Upon request to a responsible authorily,an individual sha11 be informed whether he is the subject of stored data on individuals,and whether it rs classifred as publrc,private or confidential. Upon his further request,an individual who is the subject of stored private or public data on individuals shall be shown the data without airy charge to him ancl,rf he desires,shall be informed of the content and meaning oJthat data. After an rndividual has been shown the private data and informed oJits meaning,the data need not be disclosed to him for six months thereafter unless a dispute or action pursuant�o this section is pending or additiona!data on the indivrdual has been collected or created. The responsible authority shall provide copres ojthe private or public data upon request by the individual subject of the data. The responsible authority may require the requesting person to pay the actual costs of making,cert�ing,and comprling the copres. The responsible authority shal!comply immediately,ifpossible,with arry request made pursuant to this subdivision,or withrn frve days of the date of the reques�excluding Saturdays,Sundays and lega!holydays,if immediate compliance rs not possrble. I,f he cnnnot comply with the request within that time,he shall so inform the individual,and may have an additronal ftve days within which to comply with the request,excluding Saturdays,Sundays and legal holidays. Subd.4.Procedure when data Ls not accurate or co►nplete An individual may contest the accuracy or completeness ofpublic or private data concerning himse(J.' To exercise this right, an individua!shall not�in writrng the responsible authoriry describing the nature of the disagreement. The res�onsible authority shall within 30 days either: (aJ correct the datafound to be irraccurate or incomplete attd attempt to not� past recipients of inaccurate or incomplete data,including reciprents named by the indivrdual;or(b)not�the individual thar he believes the data to be correct. Data in dispute shall be disclosed only if the individua!'s s�atement ojdisagreement is included with the disclosed data. The deterntiriation of the responsible authority may be appealed pursuant�o the provisions oJthe adminisbative procedure act relaling to contested cases. DATA PRIVACYADVISORY In accordance with M.S.13.04,Subd.2,"Rights of subjects oJdata';we would like to inform you thatyour request for a permit or license from the Ciry of Orono or arry ojits departments may require you to furnish certain private or confidential information. You are notifred lhat: /. The information you furnish will be used to determirre your quafifrcation for the permit or license requested. 2. You may refuse to supply data,but refusal may require that the City derry the permit or license. 3. The information may be shared with other local,state or federa!agencies to the extent necessary to psocess the permit or license. 4. I,f your requested permit or lice»se requires Council action to approve,some information may become public. 5. You have certain rights under M.S.I3.04(see folJowrng page)to review private data on yourself. 6. Your full name is required to process this application or permit. PLEASE PRINT First Mrddle Last Address City State Zip Phone I understand my rights as stated above. Signature 10