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v <br /> Sec.i3.04 RIGHTS OF S[JB,TECTS OF DATA _ <br /> Subd. 1. Type of data. The righa of individual on whom the data is stored or to be stored shall be as set forth in this secdon. <br /> Subd.2. Information reqirired to be givea individual. An individual asked to supply privau or confidential data conceming himself shall <br /> be informed of: (a)the purpose and inunded use of the requesred dara wi[hin the collecting State agency,political subdivision,or statewide rystem; <br /> (b)whether he may refuse oY is legally required to supply the requested data;(c)any lmown consequence azising from his supplying or refusing to supply <br /> private or confidenaal data;and(d)the idendty of orher persons or enriaes authorized by state or federal law to receive the data. This requirement shall <br /> not appty when an individual is asked to supply invesrigadve dara, pursuant to secdon 13.82,subdivision 5,to a law enforcement o�cer. <br /> The commissioner of revenue mav place the noace required under this subdivision in the individual income tax or Dropem taz refund <br /> instructions instead of on those forms. <br /> Subd.3. Access to data by individual. Upon request to a responsible authoriry,an individual shall be informed whether he is the subject <br /> of stored data on individuals,and wherher it is classified as public,private or confidential. Upon his further request,an individual who is the subject <br /> of stored private or public data on individuals shall be shown rhe data wirhout any charge W him and,-if he desires,shall be informed of the content <br /> and meaning of that dara. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for <br /> six months thereafter unless a dispute or acdon pursuant to this secdon is pending or addidonai data un the individua!has been colleeted or created. <br /> The responsible authority shall provide copies of the private or public dara upon request by the individuai subject of the data. The responsible authoriry <br /> may require the requesdng person to pay the acrual coscs of making,certifying,and compiling the copies. <br /> The responsible authoriry shall comply immediately,if possibte, with any request made pursuant to this subdivision,or wi[hin five days of <br /> the date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible. If he cannot comply with the request <br /> within that time,he shall so inform the individual,and may have an addidonal five days within which to comply with the request,excluding Saturdays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may contest the accuracy or completeness of pubtic or private <br /> data conceming himself. To exercise this right,an individual shall nodfy in wricing the responsble authoriry describing che nature of the disagreement. <br /> The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and aaempt to noafy past recipienu of <br /> inaccurate or incomplete data, including recipients named by the individual;or(b)notify the individual that he believes the data to be correcc. Data <br /> in dispute shail be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The determinadon of the responsible au[horiry may be appealed pursuant to the provisions of the administradve 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 that the City deny the permit or license. <br /> 3. The information may be shared with other local, state or federal agencies ta the extent necessary to process <br /> the pernut 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 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 /> r _ � . <br /> Fi�� iddle Last <br /> a5 � � � <br /> Address Z js3ry ) S� — -1����/�� <br /> —t b� <br /> C�� State Zip Phone <br /> I understand m stated a ve. <br /> Signature <br />