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. �_ <br /> �� <br /> Sec.13.04 RIGFTTS OF SUB.TECTS OF DATa <br /> Subd. i. Type of data. The rights of individual on whom the data is stored or to be scored shall be as set fonh in this secaon. <br /> Subd.2. Iaformation reqirired to be given individual. ?.n individual asked to supply privace or confidendal data concerning himself shalt <br /> be informed of: (a)the purpose and intPnded use of the requested dara within the collecting"state agency, politicai subdivision,or sratewide system; <br /> (b)whether he may refuse oY is legal(y required to suppty the requested data;(c)any known consequence arising from his supplying or refusing to supply <br /> private or confidential data;and(d)the idenriry of other penons or enriries authorized by state or federal iaw to receive the data. This requirement shall <br /> not apply when an individual is asked to supply invesaeadve dara, pursuanc to seccion 13.82, subdivision 5, to a law enforcement officer. <br /> The commissioner of re�enue mav place the nodce required under this subdivision in the individual income tax or propertv tax refund <br /> instructions instead of on chose forms. <br /> Subd. 3. Access to data by individual. Upon requesc to a responsible authoriry,an individual shall be informed whether he is the subject <br /> of stored data on individuals, and whecher it is classified as public, private or confidendal. Upon his further request, an individual who is the subject <br /> of stored private or public data on individuals shall be shown the 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 the private data and informed of its meaning, the data need not be disclosed to him for <br /> six months theceafrer unless a dispute or acrion pursuant to this secaon is pending or addidonal data on the individual has been collected or created. <br /> The responsible authoriry shall provide copies of the private or public data upon request by the individual subject of the data. The responsible authority <br /> may require the requesting person to pay the actual coscs of making, cemfying, and compiling the copies. ; <br /> The responsible authoriry shall comply immediately, if possible, with any request made pursuant to[his subdivision,or within five days of <br /> the date of the request,exctuding 3aturdays,Sundays and legal holidays,if immediate compliance is no[possible. If he cannot comply with the request <br /> within that time,he shall so inform the individual,and may have an addiaonal 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 public or private <br /> data conceming himsetf. To exercise[his right,an individua(shalt nodfy in wridng the responsible authoriry describing the nature of the disagreement. <br /> The responsible authoriry shall within 30 days either: (a)correct[he data found to be inaccunte or incomplete and attempt to nodfy past recipients of <br /> inaccurate or incomplete data, inciuding recipiencs named by che individual; or(b)notify the individual thac he believes rhe data to be correct. Data <br /> in dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The determination of the responsible authoriry may be appealed pursuant to the provisions of the adaunistracive 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 de[ernune 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 to the extent necessary to process <br /> the pernut or license. <br /> 4. If your requested pernut or license requires Council action to approve, some information may become <br /> public. <br /> j. You have certain rights under M.S. 13.04 (available upon request) to review private data on yourself. <br /> (. Your full name is required to process this application or permit. � <br /> \ y , j <br /> /'I <br /> r <br /> ��a ,�>: _, _ _ —� _ _ ,. <br /> First Middle Lasc <br /> •� � '� � �''�>�y�.,io��� �' <br /> Address � � � � ?,� ' ' _�', ; .'�" <br /> " �i/�vl��z ' � • _ <br /> Ciry State Zip Phone <br /> I understand my rights as stated above. <br /> , - .- � /' <br /> ;� , _ , <br /> �� � �� ;�, L ,Y <br /> Signature <br />