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.n . . • , <br /> Sec.13.04 RIGIiTS OF SUBJECTS OF DATA • <br /> Subd. 1. Type o[data. 'Ihe rights of individual on whom the data is stored or to be stored shall be as set forrh in this secaon. <br /> Subd.2. Information nqirired to be given fndividual, ,e,n indivi�iai aslced�p supp�y Private or confidential data concezning himself <br /> shall be informed of: (a)the purpose and intended use of the mquemd data wid�in the collecang state agency,polidcal subdivisio4 or staxwide <br /> sysum;(b)whether he may refuse or is IegaUy required to supply the requu�d data;(c)any Imown consequence arising from his suppiying or <br /> refusing m supply private or confidentia!data;and(d)the idendry af other persoos or effifies authorized by srate or federal law to receive the data. <br /> T6is requirement shall not apply when an individual is asked to supply im-stigadve data, pursuant to section 13.82, subdivision 5, to a law <br /> enforcement o�cer. <br /> The commissioner of revenue mav�lace the norice roauired under�is��bdivision in the individual in�ome taz r ertv tax refu <br /> instructions mstead of on those forms. <br /> Subd.3. Access to data by individual. Upon request to a respeasible authority,an individual shall be informed whether he is the <br /> subject of stored data on individuals,and whether it is classified as public,private or confidendal. Upon hu further request,an individual wha <br /> is the subject of swred private or public dara on individuals shall be shown the c'ara withwt any chazge ro him and,if he desires,shall be informed <br /> of the content and meanin�of that data. After an individual has been shown the private dara and informed of its meaning,the data need not be <br /> disclosed to him for six months thereafrer unless a dispute or acdon pursuant m diis secaon is pending or addidonal data on the individual has been <br /> collecud or created. The resporuible authoriry shall provide copies of the privax or public data upon request by the individual subject of ehe data. <br /> The responsible authoriry may require che requesang person to pay the actual cosu of making,certifying,and compiling the copies. <br /> Thz responsible authoriry shall comply immediately,if possible,wish any reqaest made punvant to this subdivision,or widan five days <br /> of the date of the request,excluding Saturdays,Sundays and legal holidays,�immediare compliance is not possible. If he cannot comply with <br /> the request within that time, he shall so inform the individual,and may have an addidonal five days within which to comply with the request, <br /> excluding Saturdays,Sundays and legal holidays. <br /> Subd.4. Procedure when data is aot accurate or complete. An individual may coatest the accuracy or completeness of public or <br /> private data concerning himself. To eaereise this right,an individual shall nofify in wriring the responsible authority describing the�amre of the <br /> disagreemenc The respons�'ble au�oriry shall within 30 days either. (a)corrac rhe data fou�ro be inaccurace or incomplete and attempt ro nodfy <br /> past recipients of inaccurace or i�uomplete data,including recipienu named by d:e individual;or(b)nodfy the individual that he believes the data <br /> ro be correct. Dara in dispute shall be disclosed only if the individual's sra2�ent of disagreement is included with the disclosed data. <br /> The detemunaaon of the responsible authoriry may be appealed purssant to the provisions of the administraave procedure act relating <br /> to contested cases. <br /> AATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of data", we would like to inform you that your <br /> request for a pemut or license from the �iry of Orono or any of iu departments may require you to furnish certain <br /> private or confidential information. <br /> You aze notified that: , <br /> 1. The information you furnish will be used to determine your qualification for the permit or license <br /> requested. <br /> 2. You may refuse to supply data, but refusal may require that the Ciry deny the permit or license. <br /> 3. The information may be shared with other local, state or federal agencies to the extent necessary to <br /> process the permit or license. <br /> 4. If your requested pemut or license requires Cour.cil action to approve, some information may become <br /> public. <br /> 5. You have certain rights under M.S. 13.04(available upon request) to review private data on yourself. <br /> 6. Your full name is required to process this application or permit. <br /> �O � S <br /> Firsc Mi dle �� <br /> /�!n o /� . �z.�.n � <br /> Address <br /> n�� ss3 gsZ� ��� 03 <br /> C��' Srare Zip Phone <br /> I understand my rights as stated ove. <br /> Signamre <br /> 6 <br />