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� r <br /> Sea13.04 RIGHTS OF SUBJECTS OF DATA <br /> Subd.1. Type of data. The rights of individual on whom the data is stored or to be stored shall be as set forth In this section. <br /> Subd.2. Informatlon required to be given tndlvidual. .+1n tndividual ul•ed to sa�pply private or confidenNal data concerning himseltshall be <br /> (nformed of: (a)the purpose and intended use of t6e requested dara within the mUectiag state agency,political subdivisioa,or statewide system;(b) <br /> whether he may refuse or Is legally required to supply the requested data;(c)an.•L-nowa consequeace arfsing trom his supph-Ing or refusing to supply <br /> private or confidential data;and(d)the identiry of other persons or eatlHes authoraed b.state or federal law to recefve the data This requlrement shall <br /> not apply when an iadiv(dual is asked to supply investigattve data,pursuant to sedion li.82,subdivision 5,to a law enforcement ofticer. <br /> The rnmmiss(oner of revenue mav olace the notice reaaired under this subdi�ision in the indtvidual inrnme ta�or orooertv tax re[und <br /> Lnstructions instead o[on those forms. <br /> Subd.3. Access to data by Individual. Upoa request to a responsible acthorfc�,an individual shall be informed w6ether he ts the subject of <br /> stored data on indfviduals,and whether it(s classifled as public,prn•ate or contidentlal. L'pon his further request,an indI�idual who(s tde subject of <br /> stored private or public data on individuals shall be shown the data without any charge to him and,tf he desires,shall be Informed o[the content and <br /> meaning of that data. After an indIvidual has been shown the pri��ate data and informed of its meaning,the data need not be disclosed to hlm fors(x <br /> months thereafter unless a d(spute or action pursuant to thls secHou is pending or addl�nal data on the individusl has been colleMed or crested. The <br /> responsible authority sha(I provide coptes of the p�tvate or publ(c data upon requat by the individust subject of the dsta. T6e responsible sut6orlty may <br /> require the requesting person to pay the actual costs of making,artifying,and compili�the rnpies. <br /> The responsible authority shall comply immediately,(f pnssible,wtth an.request made pursuant to this subdivistoo,or within[ive days of the <br /> date otthe request,excluding Saturdays,Sundays and legal hollda�•s,if immediate eomplisnce is not possible.If he cannot comply w(th the requat within <br /> that time,he shali so inform the individual,and may dave an additlonai tive days v�-ishlo which to comply with the request,ezcluding Saturdays,Sundays <br /> and legal6ol(days. <br /> Subd.4. Procedure when data(s not accurate or rnmplete.An lndividuil ma.contest the accuracy or rnmpletenas of public or prtvate data <br /> concerntng himself. To exercise this right,aa indiv(dual shall notif�•tn writing the rapoaa'ble suthortty describiog t6e aature of the disagreemenG The <br /> responsible authority shall within 30 days either: (a)correct the data found to be iaac�eurste or incomplete and attempt to notity past reciplents oC <br /> inaccurate or inrnmplete data,including recipients named by the[adividual;or(b)uotif�the individual that he believes the data to be correcG Data in <br /> dispute shaU be dlsclosed only if the ind(vidual'a statement of disagmment is taduded with the dtsclosed data. <br /> The determinatton o[the responsible suthority may be appealed pursaant to tLe provistons of the administratl�•e procedure aM relating 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�ou that your request <br /> for a permit or license from the City of Orono or an�•of its departmenu may require you to furnish certain private or <br /> confidential information. <br /> You are notified that: <br /> 1. The informatioa you furnish will be used to determine your qualification for the permit or licease requested. <br /> 2. You may refuse to supply dat$,but refusal may reqnire that the City deny the permit or license. <br /> 3. The information may be shared with other local,state or federal agencies to the eatent necessary to process <br /> the permit or license. <br /> 4. If your requested permit or license requires Council acuon to approve, some information may become <br /> public. <br /> 5. You have certain rights under M.S.13.0�3(available upon request)to review private data on yourself. <br /> 6. Your full name is requIred to process this application or permit. <br /> �Q� ��i�i-- o�n Qr,S' <br /> First Mlddle Last <br /> � � �� �iUd t�a� L���?l <br /> Address <br /> � �G� y��� ��/ ��� y���� <br /> City State ZIp Phone � <br /> I understand my rights as stated above. . <br /> Signature <br />