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� 4 <br /> Sec.13.04 RIGHTS OF SUBJECTS OF D�T� <br /> Subd. 1. Type of data. The righrs of individual on whom�he data is stored or to be scored shall be as sec forth in this secdon. <br /> Subd.2. Information required to be�ven indi�idual. �n individua!asked to supply privace or confidenaal dara conceming himself shall <br /> be informed of: (a) the purpose and in[ended use o[the �quested data wi[hin the collecring'state agency, polirical subdivisioo, or statewide system; <br /> (b)whe�her he may reiuse or is legally required to supply che requesced dara;(c)any lmown consequence arising from his supplying or refusing to supply <br /> private or confidendal data:and(d)the identiry of o[her persons or enddes authorized by state or federal law ro receive the data. This requirement shall <br /> not apply when an individual is asked to supply invesdgaave data, pursuanc to secaon 13.82, subdivision�, to a law enforeement oificer. <br /> The commissioner of r venue ma� olac� �h� nodc� r�auired under this subdivision in the individual income taz or oropem taz reiund <br /> instructions instead of on those forms. <br /> 5ubd. 3. .�ccess to data by individual. lipon request to a responsible auchoriry,an individual shall be informed whecher he is the subjec[ <br /> of stored data on individuals, and whecher it is classuied�s puolic, pnva[e or conndendal. L`pon his further reauest, an individual who is the subject <br /> of stored private or public data on individuals shall be shown �he data wi[hout any charge to hun and, ii he desires, shall be informed of the content <br /> and meaning of tha[data. ?.frer an individual has been shown the priva�e data and iniormed of irs meaning, [he data need not be disclosed to hun for <br /> six mon[hs thereahec unless a dispute or ac[ion pursuan�to this secnon is pending or additional data on the individual has been collected or created. <br /> The responsible au[horiry shall provide copizs of[he pm ate or public data upon request by the individual subject ot the data. The responsible authoriry <br /> may require the requesang person to pay che actual cos�s of making, cera[yinz, and compiling rhe copies. <br /> The responsible au[horiry shall compiy immedia[ely, if possibie, wich any request made pursuan[to this subdivision, or wi[hin five days of <br /> the date ot the reques[, excluding Sa�urdays,Sundays and legal holidays,if immediare compliance is not possible. If he cannot comply with[he requesL <br /> within[ha[time,he shall so iniorm the individual,and may have an additional five days wi[hin which ro comply with the request,excluding Sarurdays, <br /> Sundays and legal holidays. <br /> Subd.d. Procedure when data is not accurate or complete. An individual may concest[he accuracy or compleceness of public or private <br /> data conceming himself. To exercise this rieht,an individual shall no�ity in wri�ing the responsible auchoriry describing[he nature of the disagreement. <br /> The responsible auchoriry shall wi[hin 30 days eicher: (a)correct the data found to be inaccurace or incomplete and attempc to norify past recipients oi <br /> inaccurate or incomplece data. includine recipiencs named by [he individual; or(b)nodfy the individual tha[he believes [he data ro be correct. Data <br /> in dispute shall be disclosed only if the individual's staeemenc of disaereement is included wi[h the disdosed data. <br /> The determination of the resQonsible authori[y may be appealed pursuant to the provisions of[he admuustrarive procedure ac[ relating �o <br /> contested cases. <br /> D�T:� PRIVACY aDVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inTorm you that your request <br /> for a permit or license from the Ciry of Orono or any of its departmen[s may require you to furnish certain private or <br /> confiden�ial information. <br /> ';ou are r.ocified t:at: <br /> 1. The information you Turnish will be used to determine your qualification for the permit or license requested. <br /> 2. You may refuse to supply data, buc refusal may require that the City deny the permit or license. <br /> 3. The inTocmation may be shared with other local, state or federal agencies to the extent necessary to process <br /> the permit or license. <br /> 4. If your requested permit or license requires Council action to approve, some information may become <br /> public. <br /> 5. You have certain rioh�s under �1.5. 13.04 (available upon request) to review private data on yourself. <br /> (. Your full name is required to process this application or permit. <br /> ��L �}- �C_� (� J���. <br /> F�rst x:aa�z �S` <br /> �r�t� i5��t� ��A r—� �'c�� <br /> Address <br /> �; ��� m� 5�3��- �rZ—�� – �4z� <br /> C�ry Stace Zip Phone <br /> I understand rights as stated above. <br /> �I. � � <br /> Signature <br />