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. <br /> Sec.13.04 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[orth in this section. <br /> Subd.2. Information required to be given individual. An individual asked to supply private or confidential data concerning himself shall be <br /> informed of: (a)the purpose and intended use of the requested data within the wllecting state agency,political subdivision,or statewide system;(b) <br /> whether he may re[use or is legally required to supply the requested data;(c)any known consequence arising from his suppiying or refusing to supply <br /> private or confidential data;and(d)the identity of other persons or entities authorized by state or federal law to receive the data. This requirement shall <br /> not apply when an individual is asked to supply investigative data,pursuant to section 13.82,subdivision 5,to a law enforcement of£cer. <br /> The commissioner of revenue mav alace the notice reauired under this subdivision in the individual income tax or oropertv tax re[und <br /> instructions instead of on those forms. <br /> Subd.3. Access to data by individual. Upon request to a responsible authority,an individual shall be in(ormed whether he is the subject o( <br /> stored data on individuals,and whether it is classified as public,private or confidential. Upon his further request,an individual who is the subject o[ <br /> stored private or public data on individuals shall be shown the data without any charge to him and,if he desires,shall be in[ormed of the content and <br /> meaning of that data. After an individual has been shown the private data and informed of its meaning,the data need not be disclosed to him for siz <br /> months thereafter unless a dispute or action pursuant to this section is pending or additional data on the individual has been collected or created. The <br /> responsible authority shall provide copies of the private or public data upon request by the individual subject o[the data. The responsible authority may <br /> require the requesting person to pay the actual costs of making,certifying,and compiling the copies. <br /> The responsible authority shall comply immediately,if possible,with any request made pursuant to this subdivision,or within five days ofthe <br /> date of the request,excluding Saturdays,Sundays and legal holidays,if immediate compliance is not possible.If he cannot comply with the request within <br /> that time,he shall so inform the individual,and may have an additional Gve days within which to comply with the requesy excluding Saturdays,Sundays <br /> 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 data <br /> concerning himself. To exercise this right,an individual shall notify in writing the responsible authority describing the nature of the disagreement. The <br /> responsible authority shall within 30 days either: (a)correct the data found to be inaccurate or incomplete and attempt to notify past recipients of <br /> inaccurate or incomplete data,including recipients named by the individual;or(b)notify the individual that he believes the data to be correct. Data in <br /> dispute shall be disclosed only if the individual's statement of disagreement is included with the disclosed data. <br /> The determination of the responsible authority may be appealed pursuant to the provisions of the administrative procedure act 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 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 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 Ni.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 /> , � /�. 1 i <br /> 1� ;� � � r�r,7_�.� .�--� ,; { ;---��� � i <br /> ' i <br /> First Nliddle Last <br /> � � J ��� C��.�� j����� ��'�1 <br /> Address <br /> •---� � � _ <br /> �--�.� �M �% i.�-��4, ���,r� ��r.� ���� � , � _ __,��� � ; .� �; 7 <br /> C��Y State Zip y ��Phone � � � ' r <br /> I understand m rights�sta�ted�bove. � <br /> �� �� � � " --��' ���� � <br /> , � <br /> Signature <br />