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� <br /> Sec.13.04 RIGH'TS OF SUBJECTS OF DATA <br /> Subd. 1. Type of data. Ihe righrs of individua(on whom the data is stored or to be stored shall be as set for[h in this secdon. <br /> Subd.2. Information reqirired to be givea individual. An individual asked w supply private or confidendal dara conceming himself shall <br /> be informed of: (a)the purpose and inteaded use of che requesud data within the collecting State agency,political subdivision,or sratewide rystem; <br /> (b)whe[fier he may refuse oY is legally required to supply the cequesud dara:(c)any imown consequence arising from his supplying or refusing to supply <br /> • privace or confidendal data;and(d)the idenriry of other persons or enriaes au[harized by state or fedecai law to receive the data. This requirement shall <br /> not apply when an individual is asked to suppty invesdgadve data,pursuant to secaon 13.82,subdivision 5, to a law enforcement o�cer. - <br /> The commissioner of revenue mav place the nodce reauired under this subdivision in the individual income tax or provem taz cefund <br /> insm►cdons inscead of on rhose forms. <br /> ' Subd. 3. Access to data by individual. Upon request to a responsible au[hority,an individual shall be informed whether he is the subject <br /> of stored data on individuals,and whe�her it is class�ed as public,private or confidenaal. Upon his furthec request,an individual who is the subjecc <br /> of scor�d private or public dara on individuais shall be shown[he data wichout any charge to him and;if he desires, shall be informed of the content <br /> and meaning of rhat data. After an individual has been shown[he private data and iaformed of iu meaning,the data need not be disclosed ro trim for <br /> six months thereafter unless a dispute or acaon pursuanc to [his secaon is pznding or addiaonal data on rhe individual has been cotlected or created. <br /> The responsibie authoriry shall provide copies of[he private or public data upon request by rhe individuai subject of the dara. The responsible authoricy <br /> may require the requesring person to pay the actual costs of making,certifying,and compiling the copies. <br /> The responsible aurhoriry shall compiy immediately,if possible,with any request made pursuant to this subdivision,or wirhin five days of <br /> the date of the request,exciuding Saturdays,Sundays and legal holidays,if immedia�e compliance is not possible. If he cannot comply with the request <br /> within[hat time,he shall so inform che individual,and may have an addiaonal five days within which W comply with the request,exciuding Saaudays, <br /> Sundays and legal holidays. <br /> Subd.4. Procedure when data is not accurate or complete. An individual may conust the accuracy or completeness of public or private <br /> data concerning himself. To exercise[his righG an individuai shall noafy in writing the responsible authority describing the nacuro of the disagreement. <br /> The responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to nodfy past recipienu of <br /> inaccurate or incomplete dan, ineiuding recipienrs named by[he individual; or(b)nodfy the individual thac he believes the dara to be correcc. Data <br /> in dispute shall be disclosed only if the individual's statement of disagreement u included with rhe disclosed data. <br /> The determinaaon of the responsible authority may be appealed pursuanc to�e provisions of[he adminisaarive procedure act reladng to <br /> conusud cases. <br /> DATA PRIVACY ADVISORY <br /> In accordance with M.S. 13.04, Subd.2, "Riehts of subjects of data", we would like to inform you that your request <br /> for a pemut or license from the Ciry of Orono or any of its departments may require you to fumish 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 shazed 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 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 permic. <br /> � <br /> `��� � �m�� <br /> First Middie Last <br /> ��7� �:'/Vw6n� 'QLv� <br /> Address <br /> �YlC7 c�rv/� U1�1'�. S�S'��G� L-�7� — `�"-�� <br /> � <br /> City State Z�p Phone <br /> I derstand my ri,gh as st e above. <br /> Signature <br />