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r <br /> � <br /> Sec.13.04 RIGHTS OF SUBJECTS OF D�.T?, <br /> Subd. 1. Type of data. 'Ihe rights of individual on wtiom the data is stored or to be stored shall be as set forth in this secdon. <br /> Subd.2. Information reqirired to be�ven individual. An individual asked to supply private or confidenoal data concerning himself shall <br /> be informed of: (a) the purpose and incended use of che requested daca wichin[he collecting'srare ageacy, polirical subdivision,or stacewide system; <br /> (b)whether he may refuse or is le�ally required to supply the requested data;(c)any Imown consequence arising from his supplying or refusing to supply <br /> private or confidenoal data;and(d)che idendry of o�her p�rsons or enddes authorized by state or federal law to receive che data. This requirement shall <br /> noc appty when an individual is asked to supply invesdgaave daca, pursuan�to secnon 13.82, subdivision 5, to a law enforcemen[o�cer. <br /> The commissioner of revenue mav place the norice required under this subdivision in [he individual income tax or prooem taz tefund <br /> instrucrions instead of on those forms. <br /> Subd. 3. Access to data by individual. Upon request to a r�sponsible auchoriry,an individual shall be informed whether he is the subject <br /> of stored data on individuals, and wherher it is classified as pub(ic, priva�e or confidenoal. Upon his fur�her request, an individual who is the subjecc <br /> of stored private or pub(ic dara on individuals shall be shown the data wi[hout any charge to hun and, if he desires, shall be informed of the content <br /> and meaning of that data. Afrer an individuai has been shown�he privace data and informed of irs meaning, che da�a need noc be disclosed to him for <br /> six months thereafter unless a dispure or acrion pursuant[o this secdon is pending or addidonal data oa the individual 6as been collected or creaced. <br /> The responsible authoriry shaIl provide copies of the private or public data upon request by the individual subject of the data. The responsible authority <br /> may require the requesring penon to pay rhe actual coscs of making, cerrifying, and compiling the copies. <br /> The responsible authoriry shall comply immediately, if possible, with any request made pursuant to[his subdivision, or wi[hin five days of <br /> the date of the request,exctuding Satu�ays,Sundays and legal holidays,if immediate compliance is not possible. If he cannoc comply with the requesc <br /> wirhin that time,he shall so inform the individual,and may have an addidonal five days within which to comp[y with the request,excluding Saturdays, <br /> Sundays and legat holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contesc the accuracy or completeness of public or private <br /> data conceming himself. To exercise chis right,an individual shall norify in wriring the responsible authoriry describing the na[ure of the disagreemenc. <br /> The responsible authoriry shall wirhin 30 days either: (a)correcc the data found to be inaccurace or incomplete and attempt to nodfy past recipienes of <br /> inaccurace or incomplere data, including recipients named by the individual; or(b)noafy che individual chat he believes the data to be correct. Data <br /> in dispute shali be disclosed only if[he individual's statement of disagreement is inctuded with the disclosed daca. <br /> The detertninacion of the responsible auchoriry may be appealed pursuan�to the provisions of the adrtunistradve procedure act relaang to <br /> contested cases. <br /> DATA 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 request <br /> for a permit or license from the City of Orono or any of its departments may require you to furnish certain private or <br /> confidential information. <br /> You are notified that: <br /> 1. The information you furnish will be used to determine your qualification for the permit or license requested. <br /> 2. You may refuse to supply data, but refusal may require [hat the City deny the permit or license. <br /> 3. The information may be shared with other local, state or federal agencies to the exten[necessary to process <br /> the permit or license. <br /> 4. If your requested perm.it or license requires Council 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 perm.it. <br /> f <br /> , �, � <br /> 1`�.?�2�`"`%i ._ � l� ��,. <br /> First , -� , Middle � � Last <br /> /��� %��� �.� � ' �_ �� �7 <br /> ,� <br /> Address �/ �--- ��' , ���/7� ,'/`��� �n, �� <br /> �, �, <br /> -�� ii i �, (1 <br /> �/�i �.� ,��� � �`/ ✓� -- -- � � <br /> C�h, � State Zip L Phone <br /> I understand my righu as stated above. <br /> -�� " ; / ,___/ � y <br /> /�ii i T' 9�y" � �' � '`;�--- - <br /> Signacure ' <br />